METHOD FOR A SINGLE-PLASTED BREAST PLASTIC IN ORGAN-CONSERVING SURGICAL TREATMENT OF CANCER IN LOCALIZATION OF THE TUMOR IN INTERNAL QUADRANTS

摘要

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to oncology and surgery. Perform preoperative marking, resection of the breast and axillary-subclavian-subscapular lymphadenectomy. At close location of the tumor to the skin during preoperative marking, a clear contour of the excised skin over the tumor is applied, taking into account the closure of the defect by the displaced skin-glandular flap. Marking is carried out in the patient standing position. Determine the necessary volume and size of the sector to be removed, mark lines of the median line, middle meridian of the mammary gland – l. medioclavicularis from the middle of the clavicle through the nipple, middle of the lower slope, submammary fold, line of submammary fold. Mark the point of the new position of the nipple, located 20 cm from the jugular tenderloin of the sternum to the middle of the submammary fold of the breast. Lateral meridian is planned by shifting the gland upward and medially and connecting the point of the new location of the nipple to the middle of the submammary fold. Medial meridian is planned by shifting the gland upwards and laterally and connecting the point of the new location of the nipple with the middle of the submammary fold, determine the upper edge of the new location of the areola, from the point of the new position of the nipple, lay 5 cm along the medial and lateral meridians and put a marking mark, from the latter lay 6 cm down along the lateral and medial meridians and put a marking mark. From the last label, a horizontal line is drawn after the mammary gland is displaced laterally in the direction of the median line to the submammary fold, after the mammary gland is displaced medially, the horizontal line is laterally drawn to the submammary fold, corresponding to the marking of the sector with the tumor, cutaneous incisions are performed. Remove the sector with the tumor and skin integuments over it to the fascia of the large pectoral muscle. Sector is sent for urgent morphological examination and when receiving a response about negative margins of resection proceed to the next stage. After the fixation of the metal staples in the tumor bed from a separate incision in the axillary region, regional lymphadenectomy is performed, then cutaneous lines are performed along the marking lines, de-epidermisation of this zone is performed, in the zone of projection of a new areola to create the space necessary for the turn of the upper-lateral glandular pedicle, remove the glandular tissues of the upper-medial semicircle, remove the glandular tissue. Upper-lateral and lower dermal-glandular pedicle are formed by a single flap depth to the fascia of the large pectoral muscle, using the electrocoagulator connect the glandular foot zone and the region of the distant sector of the mammary gland with the tumor, thereby creating a tunnel for moving the glandular leg into the region of the remote sector. Leg is separated from the fascia to the periareolar zone and unfolded, moving to the region of the distant sector of the breast, where after the formation of the donor skin flap according to the size of the defect is fixed with individual nodal seams with an atraumatic thread to the nearest sections of the glandular tissue in the recipient zone, and the lower lateral and medial triangular fragments of the mammary gland are removed. Areola is moved to the level of the upper incision and fixed, after which the skin-subcutaneous flaps of the lower quadrants are layered in layers, carrying out one-stage mastopexy. Further, wounds in the area of the reconstructed mammary gland and axillary region are layer-by-layer sutured with the application of an intradermal cosmetic suture and the removal of the vacuum drains in the axillary region and in the retromammary space, which are withdrawn through the counterparts.EFFECT: method allows to simultaneously carry out the plasty of the mammary gland with its own tissues, make up for the defect of the glandular tissue when the tumor is removed in the inner quadrants, and also to fill the defect of the skin over the tumor and achieve excellent and good cosmetic results after surgical treatment.1 cl, 2 ex, 23 dwg