METHOD FOR REDUCTION MAMMAPLASTY IN MACROMASTIA WITH A DISTANCE OF MORE THAN 30 CM FROM THE SUPRASTERNAL NOTCH TO THE NIPPLE, AND IN THE CASE OF PRESENCE OF MORE THAN 5 CM OF SKIN BETWEEN THE LOWER EDGE OF THE NEW NIPPLE-AREOLA COMPLEX AND THE UPPER EDGE OF THE EXISTING NIPPLE-AREOLA COMPLEX Russian patent published in 2022 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to aesthetic surgery. In the standing position, the place of the new position of the nipple is marked at a distance of 19 to 22 cm from the suprasternal notch to the nipple in the form of a point at the intersection of the projection of the inframammary fold and the median line of the mammary gland on the anterior surface of the mammary gland. The place of the new position of the nipple-areola complex (NAC) is then marked around the point of the new nipple with a diameter of 3.0 to 4.0 cm. A 8 to 10 cm straight horizontal line is then drawn on the skin of the mammary gland at a distance of 5 to 6 cm downwards from the lower edge of the marking of the new areola. The patient is transferred to a supine position, the lower incision is marked along the lower edge of the spot of the mammary gland in the form of an wavy line, wherein the line is arcuate in the middle, 8 to 10 cm long; the wavy line is drawn at a distance of 2.0 to 2.5 cm above the inframammary fold along the midline of the breast. The end sections of the lower incision line and the arcuate segment of the line in the middle of the spot of the mammary gland are positioned at a distance of 1.0 to 1.5 cm above the inframammary fold on the lateral surfaces of the mammary glands. The patient is moved to a standing position, the upper incision is marked from both ends of the horizontal straight line under the marking of the new NAC. Straight lines are drawn along the lateral, inner, and outer surfaces of the mammary gland until intersection with the lower incision lines, without extending to the skin of the chest wall. The dissection boundary of the upper skin flap is then drawn as a line at the level of the III rib and the level of the Wuringer vascular septum is marked as a point applied to the skin of the sternum in the projection of the V rib. The lower horizontal pedicle is marked, wherefor an arcuate line is drawn that outlining the upper semicircle above the existing nipple and at a distance of 4.0 to 4.5 cm, and two straight lines are drawn downwards to the mid-distance from the edge of the lower straight line to the end of the lower incision along the inframammary fold. The skin of both mammary glands is then infiltrated along the marked contour of the surgical field over the entire marking area, and skin incisions are made according to the marking. The skin is de-epidermised between the incision along the arcuate lines above the existing NAC on both sides and the lower incision above the inframammary fold. An upper incision is then made, extending towards the III rib, and a skin flap is dissected over the mammary gland up to the upper edge of the III rib, the parenchyma is dissected over the fascia of the pectoralis major muscle, prosecting the mammary gland parenchyma from the Wuringer vascular septum along the fascia up to the upper edge of the V rib. A section of the mammary parenchyma with the skin is removed between the incision under the upper flap and the semilunar incision around the existing NAC descending to the lower incision forming a pedicle, after a pedicle is formed with a Wuringer vascular septum. The mammary gland is remodelled, followed by covering the remodelled mammary gland with the upper skin-fat flap. A circle out for a new NAC is cut on the skin of the flap according to the circular marking and de-epidermised. The skin in the circle is de-epidermised and dissected crosswise, through the skin-fat flap, forming four de-epidermised flaps. The fat in the middle of the circle is removed, resulting in a through hole for a new NAC. The NAC is secured in the new position, suturing the tops of each of the four de-epidermised triangular flaps to the NAC on the pedicle with interrupted sutures below the edge of the new NAC. A second continuous subdermal suture is applied above the previous interrupted suture, suturing to the skin of the newly formed NAC. The horizontal wounds are sutured by infolding the skin of the upper incision from the edges to the middle thereof, matching the edges of the upper and lower edges of the mammary wound.

EFFECT: possibility of removing any set volume of breast tissue while maintaining better blood supply to the nipple and lactation without losing the aesthetic component.

5 cl, 50 dwg, 3 ex