METHOD OF PREPECTORAL RECONSTRUCTION OF MAMMARY GLANDS AFTER SKIN-PRESERVING MASTECTOMY Russian patent published in 2023 - IPC A61B17/00 A61F2/12 A61K35/35 A61P43/00 

FIELD: medicine; plastic surgery; oncology.

SUBSTANCE: arcuate incision is made along the contour of the nipple-areolar complex, then skin-preserving mastectomy with layer-by-layer wound closure is performed. Regional lymph node dissection through a separate axillary access with the installation of active drainage is performed. A skin incision up to 1.5 mm long is made along the submammary fold with the introduction of sodium chloride solution through the cannula for lipofilling, checking the tightness of the formed cavity, followed by the introduction of adipose tissue harvested from donor zones through the cannula, and layer-by-layer suturing of the wound. A blunt-ended cannula with a diameter of 3–4 mm is inserted into the hole towards the cavity from the mastectomy with penetration into the previously obtained subcutaneous pocket. Adipose tissue is injected through the cannula, previously cleared of fibrous fibers and excess infiltration fluid to its content of 3–5%, with a bolus of 10–15% more than the volume of the removed preparation. Access for the cannula is not sutured; at the end of the operation, the formed mammary gland is taped with adhesive tape to the collarbone and sternum. Care of postoperative sutures is taken, compression underwear is put on and worn during the entire period of prefabrication. 1.5–2 months after the operation, using ultrasound, the wall thickness of the capsule formed around the bolus is determined. At 2.5–3 mm, delayed breast reconstruction is performed by replacing the fat mass of the bolus with a silicone breast implant, the volume of which is calculated by measuring the width of the base of the breast in centimeters minus the thickness of the medial and lateral walls of the reconstructed breast, measured using ultrasound research.

EFFECT: method makes it possible to preserve the volume of the skin cover with the natural formation of a fibrous capsule after subcutaneous mastectomy, to reduce the frequency of postoperative complications, to increase the therapeutic efficiency of reconstruction, to achieve static and dynamic symmetry of the mammary gland, which affects the emotional and mental state of women who underwent mastectomy, and also eliminates the use of tissue expanders, reduces the risk of postoperative complications; provides a reduction in the number of hospitalizations to achieve the final aesthetic result and reduces the economic costs of treatment.

1 cl, 2 ex, 4 dwg