Background: In breast reconstructive surgery, the inframammary fold (IMF) is an essential component of breast identity. The lack of the IMF following previous mastectomy requires restoration. We have developed a new IMF reconstruction technique using the posterior sheet (PS) of the expander capsule.This article presents our 10-year experience of performing this original technique during two-stage breast reconstruction.Methods: Preoperatively, the midline, lateral, and medial borders (MBs) of the implant pocket and the new IMF line were marked. After extracting the expander, the anterior sheet of the expander capsule was removed with the exception of its lowest 2-cm portion. Two needles were placed at the intersection of the new IMF line with the lateral border (LB) of the implant pocket and its MB. Within the pocket, horizontal dissection of the PS of the capsule was performed from one needle to another, after which the sheet was mobilized downward. The mobilized free border of the PS was pulled upward until the inframammary crease was at the new marked location, and then fixed with non-absorbable interrupted sutures to the underlying tissues. An implant was placed over this layer. The covering tissues were then closed.Results: A total of 321 patients were included. The median age was 38 years (range, 18-58 years). No serious wound complications were observed. Breast-thoracic angle decreased in 21 patients (6.5%), and the distance from the IMF to the lower border of breast segment III was greater than that of the contralateral breast in 14 patients (4.4%).
Conclusion:This technique provides a well-defined IMF without indentations or retraction. The results are stable on long-term follow-up and provide a sharp breast-thoracic angle, which is crucial in creating natural-looking ptosis of the reconstructed breast.
Выполнение аксиллярной лимфодиссекции приводит к формированию полости, в которой после операции скапливается серозная жидкость и вызывает образование серомы. Большая частота развития данного осложнение вызывает необходимость применения профилактических мероприятий, эффективное применение которых позволит снизить экономическую нагрузку на лечебное учреждение, ускорить реабилитацию пациентов и повысить качество их жизни. В статье представлена оценка эффективности применения интраоперационных методов профилактики образования сером, с целью определения наиболее оптимального способа.
Axillary dissection leads to the formation of a cavity in which serous fluid accumulates after surgery and causes seroma formation. The high frequency of this complication causes the need for preventive measures. Effective use of this preventive measures will reduce the economic burden on the medical institution, accelerate the rehabilitation of patients and improve their quality of life. This review article presents an analysis of the causes of formation and possible methods for preventing the development of seroma, with an assessment of their effectiveness.
The Inframammary fold (IMF) is an important component of attractive and esthetically normal appearance of the breast and one of the most important elements of natural breast ptosis. It plays a significant role in the formation and maintenance of breast shape as well as it provides support for the implants placed subpectoral that prevent their malposition. It is necessary to restore the IMF during breast reconstruction and it allows achieving results similar to their natural breasts. The IMF reconstruction existing methods on a row with the advantages have some disadvantages: visible scars and contour irregularities in case of the external access, indentations at the site of IMF, little ptosis improvement or small projection, therefore it is impossible to choice a particular method of its reconstruction. Considering certain shortcomings of the existing methods of reconstruction Prof. A. Ismagilov et al. have developed a new IMF reconstruction technique using the posterior sheet of the expander capsule. This article presents our 4-year experience of performing this original technique during two-stage breast reconstruction.
Reconstruction of natural-looking breast involves the restoration of all the constituent elements that define the identity of a normal breast. The inframammary fold is one of the main anatomical elements that determine the shape of the breast. That is why the technical features of various methods of the inframammary fold reconstruction affect the final aesthetic result of the reconstructive surgery. This article considers a comparative evaluation of the quality of life and satisfaction with the reconstructed breast after the two-stage breast reconstruction with different inframammary fold creation techniques.
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