Enlarging mammoplasty: implantation of anatomical (drop-shaped) prostheses

Anatomically shaped mammoprostheses (models 410 and 468 by McGhan) are teardrop-shaped. Their use allows achieving a more natural shape of the mammary gland. Model 410 is made of non-flowing gel, which allows maintaining a constant shape of the prosthesis even if its outer shell is damaged.

As a rule, prostheses are placed submammary. With thin skin and unexpressed fatty tissue, implantation under the pectoralis major muscle is possible.

When planning and choosing a prosthesis, they are guided mainly by the width of its base, and the volume and dimensions of the implant are determined individually using a special table. To do this, after assessing the location of the inner and outer edges of the gland, measure the width of its base (A). Then determine the desired inner border, which will expand the base of the prosthesis by the value B. The outer border is shifted by the same amount. The planned width of the mammary gland (B) is found using the formula: B = A + 2B.

The final choice of the width of the implant base depends on the volume of the gland parenchyma. When the parenchyma is practically absent, 0.5-1 cm is subtracted from the obtained value (B); with parenchyma expressed to a moderate degree - 1-1.5 cm; with a large parenchyma - 2 cm. If one gland is noticeably larger than the other, there is a different distance from the lower edge of the areola to the submammary fold (for example, 4.5 and 5.5), a separate approach is needed for each gland.

After choosing a prosthesis, marking begins. If the exact distance corresponding to the vertical and horizontal dimensions of the prosthesis is measured on the chest surface, then after forming the cavity and inserting the prosthesis, the pocket may be small. This requires removing the prosthesis and reinstalling it, which is highly undesirable.

In this regard, it is advisable to increase the vertical size of the pocket by 1.5-2 cm.

It is important to note that with the lateroposition of the mammary gland, the surgeon should not strive to achieve a narrow space between the installed prostheses, since in this case the width of the prosthesis increases sharply, and its outer border shifts to the midaxillary line.

The incision length should be at least 5 cm to avoid excessive trauma to the edges of the wound.

Access marking is performed using the method described above.

When forming a pocket for an endoprosthesis, it is necessary to use long hooks, a headlamp and a long nozzle of the electric knife, without which precise formation of the cavity is impossible. The surgeon should also have at his disposal a long needle holder and tweezers for ligating perforating vessels that can be damaged in the second and third intercostal spaces. For this reason, when forming the upper internal quadrant of the pocket, the surgeon should dissect the tissues with an electric knife very carefully, which in many cases allows the vascular bundle to be seen through the tissue in advance.

In some cases, perforating vessels prevent the pocket border from being formed at the required level, which requires their ligation. When forming a cavity, it is advisable to adhere to a certain sequence of tissue separation, which significantly simplifies this stage of the operation.

An anatomically shaped prosthesis must be installed strictly in accordance with the vertical and horizontal axes.

After installing the prosthesis (using the "sleeve") and specifying its location, the wound is sutured with a three-row continuous suture. Two deep rows of sutures are applied with vicryl No. 4/0, and the cutaneous intradermal suture is applied with a non-absorbable material - prolene No. 4/0.

The space around the prosthesis should be drained with tubes with active aspiration of wound contents for 1-3 days, depending on the amount of wound discharge.

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