Abdomenoplasty with one-stage brest endoprothesis transabdominal access

Abstract

Introduction: The desire of patients to receive the maximum aesthetic result with minimal injury and “invisibility” of postoperative hem creates major difficulties for the surgeon in determining access. During the detachment of a standart of abdominoplasty skin-fat flap is held up to the xiphoid process and lateral to the costal arch, extending to the anterior axillary line, which makes possible with sufficient technical equipment of the holding-stage augmentation mammoplasty. Aim: to improve the aesthetic result of augmentation mammoplasty using transabdominal access. Materials and Methods: The operation was performed on the patient of 34 years. Estimated volume of surgery - abdominoplasty, closure of the white line of the stomach, breast endoprosthesis through the transabdominal access. Operation: endotracheal anesthesia. The total operation time is 3hrs 40 min. Previously tracing of the surgical field was made. Standard horizontal incision above the pubis with the transition to the iliac spine. Detachment of the dermal-fat flap, bluntly and sharply, up to the xiphoid process and costal margins and laterally to the anterior axillary line. Fix diastasis between the rectus abdominis, which was 5.5cm reorganization carried out the surgical field with an aqueous solution of 1% dioxidine. Next, a tunnel was formed of about 7 cm, width to 4 cm mid-clavicular line medially and 3 cm laterally from it to the inframammary fold. The lower edge of the breast was mobilized using endoscopic techniques (KarlStorz). Then the large pectoral muscle was split by means of coagulator and created a pocket in retromuscular space. Bottom-medial fibers were cut off from the edge-sternal articulation for up to 3.0 cm, and hemostasis. In the box implant is installed (anatomic, «Mentor» 350 ml). Drainage of Redon, the drainage was taken through the axillary fossa. The tunnel was taken in 3-row suture strands of single 3/0 4/0. Similarly, on the other side. Dermolipectomy anterior abdominal wall was perfomed. The navel is fixed in orthotopic position. The anterior abdominal wall wound layers of single strands were taken in 2/0 3/0 4/0 and shed 4/0. Drainage aspiration drains. Aseptic bandage. Compression bandages and linens. Results and discussion: Serous-hemorrhagic discharge in the breast in the 1st day of about 50 ml, in the 2nd day of 30 ml, in the 3rd day of 10 ml, drains are removed. Serous-hemorrhagic discharge in the anterior abdominal wall in the 1st day is about 100 ml, in the 2nd day is about 70ml, in the 3rd day to 40 ml, drains are removed. Sutures were removed on 14th day, healing by first intention. Full recovery of the patient has started by the end of the 2nd month. Conclusions: The last follow up examination was in 13 months after the surgery. The aesthetic result satisfied the patient.