METHOD OF SINGLE-STEP BREAST RECONSTRUCTION AT ORGAN-PRESERVING SURGICAL TREATMENT OF CANCER IN EXTERNAL QUADRANTS Russian patent published in 2016 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to surgery. Performed is preoperative marking, resection of the mammary gland and subclavian-axillary-subcapular lymphadenectomy. Herewith the preoperative marking is performed in the position of the patient standing, for this purpose the median line is applied, then the vertical axis of the mammary gland, the line of the submammary fold, the new position of the nipple, the medial line due to displacement of the gland upwards and laterally and connection of the point of the new location of the nipple with the middle of the submammary fold, the lateral line due to displacement of the gland upwards and medially and connection of the point of the new location of the nipple with the middle of the submammary fold, determination of the upper edge of the new location of the areola, and, as per the calculations, from the point of the new location of the nipple on the lateral and the medial lines by 5 cm from each is laid off. Upper border of the areola is connected by a semi-ring with the marked points, then from the level of 5 cm from the upper edge of the new location of the nipple by 6 cm is laid off downward along the lateral and the medial lines and from the point by 6 cm, after the breast displacement laterally a horizontal line is marked towards the median line to the submammary fold. After the breast shift medially a horizontal line is marked in the lateral direction to the submammary fold. Respectively to the marking of the new circle of the areola and the glandular crus skin incisions are made along the lines of marking on the mammary gland and the submammary fold. That is followed by de-epidermization of this section, providing access to the outer quadrant of the breast - the area of localisation of the tumour. Sector with the tumour is removed together with the greater pectoral muscle fascia, in the tumour bed to the greater pectoral muscle metal brackets are fixed for marking area of further additional local radiation. From a separate incision in the axillary area regional lymphadenectomy is performed, in the area of the de-epidermization upper medial and lower glandular cruses are formed by a single flap with a depth to the greater pectoral muscle fascia. Crus is separated from the fascia to the periareolar zone and is turned out with moving to the area of remote sector of the external quadrant of the mammary gland, where it is fixed with separate interrupted sutures by non-traumatic suture to the nearest sections of the glandular tissue, and the lower lateral and medial fragments are removed. Then the areola is moved to the level of the upper incision, fixed, and skin and subcutaneous flaps of the lower quadrants are sutured in layers performing a single-step mastopexy. Wounds within the reconstructed breast and the axillary area are sutured in layers so that the vacuum drainage is left along the anterior axillary line in the area of the submammary fold.

EFFECT: method enables together with radical treatment of breast cancer to perform reconstruction of the mammary gland by displaced glandular flaps and mastopexy, which significantly improves the cosmetic result of the operation.

1 cl, 15 dwg