Magnifying mammoplasty: Implantation of anatomical (drop-shaped) prosthesis

Mammoprostheses of anatomical form (models 410 and 468 of the firm "McGhan") have a drop-shaped shape. Their use makes it possible to achieve a more natural form of the breast. Model 410 is made of non-flowing gel, which allows you to maintain a permanent shape of the prosthesis, even if its outer shell is damaged.

As a rule, prostheses are placed submammally. With thin skin and non-expressed fatty tissue, it is possible to implant under a large pectoral muscle.

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

The final choice of the width of the base of the implant depends on the volume of the parenchyma of the gland. When the parenchyma is practically absent, the obtained value (B) is subtracted 0.5-1 cm; with parenchyma, expressed in an average degree - 1-1.5 cm; with a large parenchyma - 2 cm. If one gland is markedly larger than the other, there is a different distance from the lower margin 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, proceed to the marking. If the exact distance corresponding to the vertical and horizontal dimensions of the prosthesis is measured on the surface of the chest, then after forming the cavity and inserting the prosthesis, the pocket may be small. This requires the removal of the prosthesis and its re-installation, 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 when the breast is laterally positioned, the surgeon should not strive to achieve a narrow space between the fixed prostheses, since in this case the width of the prosthesis sharply increases, and its outer border shifts to the middle axillary line.

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

The access markup is performed as described above.

When forming a pocket for an endoprosthesis, it is necessary to use long hooks, a headlight illuminator and a long ejector nozzle, without which precision cavity formation is impossible. The surgeon must also have at his disposal a long needle holder and tweezers for dressing perforating vessels, which can be damaged in the second and third intercostal spaces. For this reason, when forming the upper quadrant of the pocket, the surgeon must cut the tissues electronically very carefully, which in many cases allows us to see a vascular bundle transilluminated through the fiber.

In some cases, perforating vessels prevent the formation of the border of the pocket at the desired level, which requires their dressing. When forming the cavity, it is advisable to adhere to a certain sequence of tissue separation, which greatly facilitates this stage of the operation.

Prosthesis of anatomical shape should be established strictly in accordance with the vertical and horizontal axes.

After installing the prosthesis (using the "sleeve") and clarifying its location, the wound is sutured with a three-row continuous suture. Two deep rows of stitches are imposed with vikril No. 4/0, and the dermal intradermal seam with non-absorbable material - with a No. 4/0 graft.

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

[1], [2], [3], [4], [5], [6]