Augmentation mammoplasty (AMP) is performed on almost 1.5 million women worldwide. Specific features of AMP are a relatively high percentage of reoperations in the remote postoperative period: from 10% after 2 years and 20% after 6-10 years, caused by deformation of the MG contour, changes in its volume, and displacement of the prosthesis from the primary location - malposition.
Rotation of MG prostheses (RMGP) is a type of malposition. Consider the rotation of the prosthesis as its circular displacements in the plane or in 3D space. In the plane, the prosthesis moves around a certain center or point of rotation, and in 3D space, rotation occurs around a line called the axis of rotation. Due to the asymmetrical surface of anatomical implants, their rotation around one or more axes leads to serious deformations of the MG profile and deterioration of the quality of life of patients.
Data on the frequency of clinically significant (90o or more) frontal rotation of MG prostheses (RMGP) are contradictory: from 0.9% to 14%, but the frequency of rotation by lower degrees should be much higher. Questions about the causes, diagnosis, prevention and treatment of RMGP remain undeveloped.
The aim of the work was to improve the results of surgical treatment of patients with cosmetic defects of the mammary glands by developing methods for prevention and elimination of rotation of MG prostheses with strengthening the walls of the recipient cavity after augmentation mammoplasty.
\Objectives of the study:
1. To improve the method of diagnosing the rotation of MG prostheses and determine its` frequency one year and three years after submuscular augmentation mammoplasty.
2. Investigate the effect of the prosthesis on the structure of the pectoralis major muscle one and three years after submuscular augmentation mammoplasty and its relationship with the rotation of the prosthesis.
3. To improve the algorithm of treatment of rotation of MG prostheses using the developed surgical method and elimination of rotation of MG prostheses and to estimate its efficiency in the one-year postoperative period
4. To improve the surgical method of prevention of rotation of MG prostheses in primary submuscular augmentation mammoplasty and to evaluate its effectiveness in the remote postoperative period.
5. To evaluate the effectiveness of improved methods of prevention of rotation of MG prostheses on the patients quality of life.
The design of this study was approved by the Commission on Bioethical Expertise and Research Ethics at the Bogomolets National Medical University.
Research methods - clinical, histological, radiological, quality of life assessment, statistical.
The study compared two and more groups of women. In all cases, group comparisons were representative by age, body mass index (BMI), weight of prostheses, percentage of women who became pregnant and breastfed, except for the second stage, in which the last parameter was the criterion of non-inclusion in the study.
Statistical processing of the obtained data was performed using the statistical package IBMSPSS Statistics 22. Performed descriptive statistics. Evaluation of the normality of the distribution of variables was performed using the Shapiro-Wilk test. Comparison of two independent groups on one quantitative basis was performed using the Mann-Whitney U-test, comparisons of groups on a qualitative basis were performed using the χ2-Pearson test; analysis of the relationship between the two variables (traits) was performed using Spearman's correlation analysis, to determine the probability of the event depending on the values of the indicator performed a linear regression analysis. The null hypothesis of equality of variables was rejected at p <0,05.
SUMMARY
The solution of the topical issue of improving the results of surgical treatment of patients with cosmetic defects of the mammary glands by developing methods of prevention and elimination of rotation of anatomical MG prostheses with strengthening of the walls of the recipient cavity after augmentation mammoplasty is presented.
The rotation of MG prostheses is defined as a deviation from the line of symmetry of the MG over 300. A year after traditional augmentation mammoplasty rotation occurs 76,1% of implants, including unilateral - in 39 (42.9%) bilateral - in 52 (57.1%).
In women, after traditional submuscular augmentation mammoplasty after one and three years, the percentage of muscle fiber area decreases significantly and inversely depends on the weight of the prosthesis: linear R2 = 0.514 and linear R2 = 0.5594, respectively. The rotation of MG prostheses is significantly negatively correlated with the percentage of muscle fiber area (after one year: r = - 0.383; after three years: r = - 0.425).
Key words: submuscular augmentation mammoplasty, rotation of MG prostheses, diagnosis, prevention, treatment, pectoralis major muscle, morphological changes.
