Mitundu / bere / pepala lokonzanso

Kubwezeretsanso M'mawere Mutatha Kugonana

Kodi kumanganso mawere ndi chiyani?

Amayi ambiri omwe ali ndi mastectomy - opareshoni yochotsa bere lonse kuchiza kapena kupewa khansa ya m'mawere - ali ndi mwayi wosintha mawonekedwe a bere lomwe lachotsedwa.

Amayi omwe amasankha kuti mabere awo amangidwenso ali ndi njira zingapo momwe angachitire. Mabere amatha kumangidwanso pogwiritsa ntchito implants (saline kapena silicone). Amathanso kumangidwanso pogwiritsa ntchito minofu yoyenda yokha (ndiye kuti, minofu yochokera kwina kulikonse m'thupi). Nthawi zina zimagwiritsidwa ntchito pomanga bere.

Kuchita opaleshoni yomanganso mawere kumatha kuchitidwa (kapena kuyambitsidwa) panthawi ya mastectomy (yomwe imadziwika kuti kumangidwanso mwachangu) kapena itha kuchitidwa pambuyo poti matumbo a machiritso achira ndikuthandizira khansa ya m'mawere (yomwe imachedwa kuchedwa kumanganso) . Kuchedwa kumangidwanso kumatha kuchitika miyezi ingapo kapena zaka pambuyo pa mastectomy.

Pomaliza pomanganso bere, nsonga zamabele ndi areola zitha kupangidwanso pachifuwa chomangidwanso, ngati izi sizinasungidwe panthawi ya mastectomy.

Nthawi zina opaleshoni yokonzanso mawere imaphatikizapo kuchitidwa opaleshoni ina, kapena yotsalira, bere kuti mabere awiriwa azigwirizana kukula ndi mawonekedwe.

Kodi madokotala amaigwiritsa ntchito bwanji implant kuti amangenso bere la mayi?

Zomera zimayikidwa pansi pa khungu kapena pachifuwa pamisempha. (Amayi ambiri am'mimba amachitidwa pogwiritsa ntchito njira yotchedwa khungu loteteza khungu, momwe khungu lambiri la m'mawere limasungidwa kuti ligwiritsidwe ntchito pokonzanso bere.)

Zomera zimayikidwa monga gawo la magawo awiri.

• Pachigawo choyamba, dokotalayo amaika chipangizo, chotchedwa expander, pansi pa khungu chomwe chimatsalira pambuyo pa mastectomy kapena pansi pa chifuwa (1,2). Exander imadzaza ndi saline pang'onopang'ono mukamapita kukaonana ndi dokotala mukatha opaleshoni.

• Gawo lachiwiri, minofu ya pachifuwiyi itapumula ndikumachira mokwanira, chotulutsa chimachotsedwa ndikuyika chomera. Minofu pachifuwa nthawi zambiri imakhala yokonzeka kuyika miyezi 2 mpaka 6 pambuyo pa mastectomy.

Nthawi zina, kuyika kumatha kuikidwa pachifuwa panthawi ya opaleshoni yofanana ndi mastectomy-ndiye kuti, kutulutsa minofu sikugwiritsidwa ntchito kukonzekera kudzala (3).

Ochita opaleshoni akugwiritsa ntchito kwambiri zinthu zotchedwa acellular dermal matrix ngati mtundu wa scaffold kapena "gulaye" kuthandizira zokulitsa minofu ndi ma implants. Matenda a khungu lamtundu wa cell ndi mtundu wa mauna omwe amapangidwa kuchokera ku khungu lopangidwa ndi anthu kapena nkhumba lomwe lakonzedwa ndi kusungidwa kuti lichotse maselo onse kuti athetse zovuta zakukana ndi matenda.

Kodi madokotala amagwiritsa ntchito bwanji matupi a mayi kuti amangenso bere?

Pomangidwanso kwa minofu, chidutswa chokhala ndi khungu, mafuta, mitsempha yamagazi, ndipo nthawi zina minofu imachotsedwa kwina kulikonse mthupi la mayi ndipo imagwiritsidwanso ntchito kumanganso bere. Chidutswa ichi chimatchedwa chiphuphu.

Malo osiyanasiyana mthupi amatha kupereka ziphuphu pakumanganso mawere. Ziphuphu zomwe zimagwiritsidwa ntchito pomanganso mawere nthawi zambiri zimachokera m'mimba kapena kumbuyo. Komabe, amathanso kutengedwa kuchokera ntchafu kapena matako.

Kutengera ndi komwe amachokera, ziphuphu zimatha kunyamulidwa kapena zaulere.

• Ndikutambasula pedicled, minofu ndi mitsempha yamagazi yolumikizidwa imasunthira palimodzi kupyola thupi kupita ku bere. Chifukwa magazi omwe amapezeka m'thupi lomwe amangogwiritsanso ntchito kumangidwanso, mitsempha yamagazi sikuyenera kulumikizidwanso minofuyo ikasunthidwa.

• Ndi ziphuphu zaulere, minofu imadulidwa kuti isatenge magazi ake. Iyenera kuphatikizidwa ndi mitsempha yatsopano yamagazi m'chifuwa, pogwiritsa ntchito njira yotchedwa microsurgery. Izi zimapatsa chifuwa chomangidwacho magazi.

Mimba ndi kumbuyo zimaphatikizapo:

• Khungu la DIEP: Matenda amachokera m'mimba ndipo amakhala ndi khungu, mitsempha yamagazi, ndi mafuta, opanda minofu yoyambira. Chingwe chamtunduwu ndichopanda kwaulere.

• Chiphuphu cha Latissimus dorsi (LD): Matenda amachokera pakati ndi kumbuyo. Mtundu wamtunduwu umadzazidwa ukamagwiritsidwa ntchito pokonzanso mawere. (Ziphuphu za LD zingagwiritsidwenso ntchito pomanganso mitundu ina.)

• Chingwe cha SIEA (chomwe chimatchedwanso SIEP chikwapu): Minofu imachokera m'mimba monga momwe chimakhalira ndi DIEP koma imaphatikizapo mitsempha ina yamagazi. Sizimaphatikizaponso kudula minofu yam'mimba ndipo ndi chopanda kwaulere. Mtundu wamtunduwu suli mwayi kwa amayi ambiri chifukwa mitsempha yofunikira yamagazi siyokwanira kapena kulibe.

• Chingwe cha TRAM: Matenda amachokera kumunsi pamimba monga DIEP koma amaphatikizanso minofu. Itha kukhala yoyendetsedwa kapena yaulere.

Ziphuphu zotengedwa ntchafu kapena matako zimagwiritsidwa ntchito kwa azimayi omwe adachitidwapo opaleshoni yayikulu m'mimba kapena omwe alibe minofu yokwanira yomangiranso bere. Mitundu iyi yaziphuphu ndi ziphuphu zaulere. Ndi ziphuphu izi zimakhazikika nthawi zambiri zimagwiritsidwanso ntchito kuperekera kuchuluka kwa mawere.

• Chimbudzi cha IGAP: Matishu amachokera kumatako ndipo amakhala ndi khungu, mitsempha yamagazi, ndi mafuta.

• PAP chikwapu: Minofu, yopanda minofu, yomwe imabwera kuchokera kumtunda kwamkati.

• Chingwe cha SGAP: Matishu amachokera matako monga momwe amapangira IGAP, koma amaphatikizira mitsempha ina yamagazi ndipo imakhala ndi khungu, mitsempha yamafuta, ndi mafuta.

• CHIKWANGWANI cha TUG: Minofu, kuphatikiza minofu, yomwe imachokera kumtunda kwamkati.

Nthawi zina, kulowetsa ndi minofu ya thupi imagwiritsidwa ntchito limodzi. Mwachitsanzo, minofu yodziyimira payokha itha kugwiritsidwa ntchito kuphimba chokhazikitsira pakakhala kuti palibe khungu ndi minofu yokwanira pambuyo pa mastectomy yolola kukulitsa ndikugwiritsa ntchito chomera (1,2).

Kodi madokotala amapanga bwanji mawere ndi areola?

Chifuwacho chitachira kuchitidwa opaleshoni yomangidwanso ndipo malo a chifuwa pakhoma lachifuwa atakhala ndi nthawi yokhazikika, dokotala wochita opaleshoni amatha kukonzanso nsonga zamabele ndi areola. Nthawi zambiri, mawere atsopanowa amapangidwa ndikudula ndikusuntha khungu ting'onoting'ono kuchokera pachifuwa chomangidwenso kupita kumalo a nsagwada ndikuchipanga kukhala chotupa chatsopano. Miyezi ingapo atamangidwanso mawere, dotoloyu amatha kupanganso areola. Izi nthawi zambiri zimachitika pogwiritsa ntchito inki ya tattoo. Komabe, nthawi zina, zolumikizira khungu zimatha kutengedwa kuchokera kubowola kapena pamimba ndikumangirizidwa pachifuwa kuti apange areola panthawi yomanganso mawere (1).

Amayi ena omwe samapangidwanso nsonga zamankhwala angaganize zopeza chithunzi cha nsagwada yomwe idapangidwa pachifuwa chomangidwenso kuchokera kwa ojambula tattoo omwe amachita ma tattoo a 3-D.

Matenda oteteza msana wamayi ndi areola, otchedwa nipple-sparing mastectomy, atha kukhala mwayi kwa azimayi ena, kutengera kukula ndi malo a khansa ya m'mawere ndi mawonekedwe ndi kukula kwa mabere (4,5).

Ndi zinthu ziti zomwe zingakhudze nthawi yakumanganso mawere?

Chimodzi mwazinthu zomwe zingakhudze nthawi yomangidwanso ndi ngati mkazi angafunikire chithandizo cha radiation. Thandizo la radiation nthawi zina limatha kuyambitsa mavuto amachiritso a zilonda kapena matenda m'mabere omangidwanso, chifukwa chake azimayi ena amasankha kuchedwa kumanganso mpaka mankhwala atatha. Komabe, chifukwa chakuwongolera kwamankhwala opangira ma radiation ndi ma radiation, kumangidwanso nthawi yomweyo ndi choikapo nthawi zambiri kumakhalabe mwayi kwa azimayi omwe angafunike chithandizo cha radiation. Matenda a Autologous matenthedwe omangidwanso nthawi zambiri amasungidwa pambuyo pochizira ma radiation, kotero kuti chifuwa ndi chifuwa cha khoma zowonongeka ndi radiation zingalowe m'malo ndi minofu yathanzi kuchokera kwina kulikonse mthupi.

Chinthu china ndicho mtundu wa khansa ya m'mawere. Amayi omwe ali ndi khansa ya m'mawere yotupa nthawi zambiri amafuna kuchotsa khungu. Izi zitha kupangitsa kuti kumangidwako kukhale kovuta kwambiri, chifukwa chake mwina kungalimbikitsidwe kuti kumangidwako kuchedwa mpaka atamaliza mankhwala othandizira.

Ngakhale mkazi atakhala wokonzeka kumanganso nthawi yomweyo, atha kusankha kumangidwanso. Mwachitsanzo, azimayi ena samakonda kuganizira zakumangidwazo kuti akhale nazo mpaka atachira kumatumbo awo ndi chithandizo chotsatira cha adjuvant. Amayi omwe amachedwa kumanganso (kapena sanasankhe kuchita izi) atha kugwiritsa ntchito ma prostheses akunja, kapena mawere, kuti awonetse mabere.

Ndi zinthu ziti zomwe zingakhudze kusankha kwa njira yokonzanso mawere?

Zinthu zingapo zimatha kuyambitsa mtundu wamankhwala omanganso omwe mayi amasankha. Izi zikuphatikiza kukula ndi mawonekedwe a bere lomwe likumangidwanso, zaka za mayi ndi thanzi lake, mbiri yake ya maopaleshoni akale, zoopsa za opaleshoni (mwachitsanzo, kusuta fodya ndi kunenepa kwambiri), kupezeka kwa minyewa yodziyimira payokha, komanso malo a chotupa pachifuwa (2,6). Azimayi omwe adachitidwapo opaleshoni yam'mimba m'mbuyomu sangakhale oyenera kumangidwanso m'mimba.

Mtundu uliwonse wamamangidwe uli ndi zinthu zomwe mkazi ayenera kuganizira asanapange chisankho. Zina mwazinthu zomwe zafotokozedwa kwambiri zalembedwa pansipa.

Kumangidwanso ndi Zomera

Opaleshoni ndi kuchira

• Khungu ndi minofu yokwanira ziyenera kutsalira pambuyo pa mastectomy kuti zitha kubzala

• Njira zochepa zopangira opaleshoni kuposa zomangidwanso ndi minofu ya autologous; kutaya magazi pang'ono

• Nthawi yobwezeretsa ikhoza kukhala yaifupi kuposa kumangidwanso kwa autologous

• Maulendo obwereza ambiri angafunike kuti akweze zotambasulirazo ndikuyika zokhazokha

Zovuta zotheka

• Matenda

• Kudzikundikira kwamadzimadzi omveka bwino kumayambitsa misa kapena chotupa (seroma) mkati mwa bere lokonzanso (7)

• Kuphatikizira magazi (hematoma) mkati mwa bere lokonzanso

• Kuundana kwamagazi

• Kutulutsidwa kwa kokhazikikako (kulowetsa kumadutsa pakhungu)

• Kubzala kuphulika (chomera chimatseguka ndipo saline kapena silicone ikudontha minofu yoyandikana nayo)

• Kapangidwe ka minofu yolimba yolimba kuzungulira choikacho (chotchedwa contracture)

• Kunenepa kwambiri, matenda ashuga, komanso kusuta kumatha kukulitsa zovuta

• Chiwopsezo chowonjezeka chokhala ndi khansa ya chitetezo cha mthupi yotchedwa anaplastic large cell lymphoma (8,9)

Zina zofunikira

• Sizingakhale zosankha kwa odwala omwe adalandira chithandizo chamagetsi pachifuwa

• Sangakhale okwanira azimayi omwe ali ndi mabere akulu kwambiri

• Sizingakhale moyo wonse; Mkazi atakhala ndi nthawi yayitali, kumakhala kovuta kuti azikhala ndi zovuta zina

kuchotsedwa kapena kusinthidwa

• Zomera za silicone zitha kumverera mwachilengedwe kuposa zomwe zimadzala ndi saline

• Dipatimenti ya Food and Drug Administration (FDA) imalimbikitsa kuti amayi omwe ali ndi ma implants a silicone amayesedwa nthawi ndi nthawi ku MRI kuti azindikire kuphulika kwa "implants"

Zambiri pazodzala zimatha kupezeka patsamba la FDA's Breast Implants.

Kumangidwanso ndi Matenda a Autologous

Opaleshoni ndi kuchira

• Kuchita opaleshoni yayitali kuposa zopangira

• Nthawi yoyamba kuchira ikhoza kukhala yayitali kuposa zopangira

• Kukonzanso ziphuphu nthawi zambiri kumakhala kofupikitsa kuposa kumanganso kwaulere ndipo nthawi zambiri kumafuna kuchipatala kwakanthawi

• Kumanganso kwaulere kwaulere ndikutalika, kugwira ntchito mwaluso kwambiri poyerekeza ndi kumanganso kaphokoso kazitsulo komwe kumafuna dotolo yemwe amadziwa za microsurgery kuti agwirizanenso mitsempha yamagazi

Zovuta zotheka

• Necrosis (imfa) ya minofu yosamutsidwa

• Mitsempha yamagazi imatha kupezeka pafupipafupi ndi zina

• Zowawa ndi kufooka pamalo pomwe zidaperekedwazo

• Kunenepa kwambiri, matenda ashuga, komanso kusuta kumatha kukulitsa zovuta

Zina zofunikira

• Mutha kupereka mawonekedwe achilengedwe kuposa ma implants

• Angamve kukhala ofewa komanso achirengedwe kukhudza kuposa ma implants

• Amasiya chilonda pamalopo pomwe zidaperekedwazo

• Itha kugwiritsidwa ntchito m'malo mwa minofu yomwe yawonongeka ndi ma radiation

Amayi onse omwe amachitidwa chifuwa chachikulu cha khansa ya m'mawere amamva kupweteka kwam'mimba mosiyanasiyana komanso kutengeka (kumva) chifukwa mitsempha yomwe imapangitsa kumva kuwawa pachifuwa imadulidwa pamene minofu ya m'mawere imachotsedwa pakuchita opaleshoni. Komabe, mayi amatha kupezanso mphamvu akamva misempha yoduka ikukula ndikubwezeretsanso, ndipo madokotala ochita mawere akupitiliza kuchita ukadaulo waluso womwe ungapewe kapena kukonzetsa kuwonongeka kwa mitsempha.

Mtundu uliwonse wamatenda omangidwanso amatha kulephera ngati kuchira sikuchitika bwino. Pazochitikazi, kuyika kapena kukulunga kuyenera kuchotsedwa. Ngati kumangidwanso kumalephera, mzimayi amatha kumangidwanso kachiwiri pogwiritsa ntchito njira ina.

Kodi inshuwaransi yazaumoyo idzalipiranso kukonzanso kwa mawere?

Lamulo la Women's Health and Cancer Rights Act la 1998 (WHCRA) ndi lamulo lalamulo lomwe limafunikira mapulani azaumoyo am'magulu ndi makampani a inshuwaransi azaumoyo omwe amapereka chimbudzi kuti alipiranso opaleshoni yomanganso pambuyo pa mastectomy. Kuphatikizaku kuyenera kuphatikiza magawo onse omangidwanso ndi opareshoni kuti akwaniritse kufanana pakati pa mabere, ma prostheses am'mawere, ndikuchiza zovuta zomwe zimadza chifukwa cha mastectomy, kuphatikiza lymphedema. Zambiri zokhudzana ndi WHCRA zimapezeka kuchokera ku department of Labor ndi Centers for Medicare & Medicaid Services.

Madongosolo ena azaumoyo omwe amathandizidwa ndi mabungwe azipembedzo komanso mapulani ena aboma atha kukhala opanda WHCRA. Komanso, WHCRA siyikugwira ntchito ku Medicare ndi Medicaid. Komabe, Medicare imatha kuphimba maopareshoni omanganso mawere komanso ma prostheses akunja am'mimba (kuphatikiza bulasi pambuyo pochita opaleshoni) pambuyo pa mastectomy ofunikira azamankhwala.

Mapindu a Medicaid amasiyana malinga ndi mayiko; mayi ayenera kulumikizana ndi ofesi yake ya Medicaid kuti adziwe ngati, komanso mpaka pati, kumanganso mawere kumaphimbidwa.

Mzimayi amene akuganiza zomanganso mawere angafune kukambirana za mtengo ndi inshuwaransi yazaumoyo ndi dokotala komanso kampani yake ya inshuwaransi asanasankhe kuchitidwa opaleshoni. Makampani ena a inshuwaransi amafuna lingaliro lachiwiri asanavomere kulipira opaleshoni.

Ndi chisamaliro chiti chotsatira ndikubwezeretsa chofunikira pakamangidwe kachifuwa?

Mtundu uliwonse wamamangidwe umawonjezera mavuto omwe mayi akhoza kukhala nawo poyerekeza ndi omwe amabwera pambuyo pa mastectomy okha. Gulu lazachipatala la mayi limamuyang'anitsitsa kuti akumane ndi zovuta, zina zomwe zimatha kuchitika miyezi ingapo kapena zaka atachitidwa opaleshoni (1,2,10).

Amayi omwe ali ndi minofu yodzipangira okha kapena kumangidwanso komwe angakhazikitsidwe atha kupindula ndi chithandizo chamankhwala kuti asinthe kapena kusuntha mayendedwe osiyanasiyana kapena kuwathandiza kuti atuluke kufooka komwe amapezeka patsamba lomwe zidaperekedwazo, monga kufooka m'mimba (11,12) ). Katswiri wazachipatala atha kuthandiza mayi kugwiritsa ntchito zolimbitsa thupi kuti apezenso nyonga, kusintha zina ndi zina, ndikupeza njira zabwino kwambiri zochitira zinthu za tsiku ndi tsiku.

Kodi kumanganso mawere kumakhudza kuthekera kowunika ngati khansa ya m'mawere ibwerezedwanso?

Kafukufuku wasonyeza kuti kumanganso mawere sikuwonjezera mwayi wakubwera khansa ya m'mawere kapena kumapangitsa kuti zikhale zovuta kuti muwone ngati zingachitike ndi mammography (13).

Amayi omwe adachotsa bere limodzi ndi mastectomy amakhalabe ndi mammograms a bere lina. Azimayi omwe adachitapo khungu losamala khungu kapena omwe ali pachiwopsezo chachikulu chobwereranso ndi khansa ya m'mawere atha kukhala ndi mammograms a bere lomangidwanso ngati litamangidwanso pogwiritsa ntchito minofu ya autologous. Komabe, mammograms nthawi zambiri samachitidwa pa mabere omwe amapangidwanso ndikulowetsedwa pambuyo pa mastectomy.

Mzimayi wokhala ndi bere ayenera kuuza wopanga ma radiation za zomwe amadzala asanayambe mammogram. Njira zapadera zitha kukhala zofunikira kukonza mammogram komanso kupewa kuwononga chomera.

Zambiri zama mammograms zitha kupezeka mu NCI Mammograms.

Kodi ndi zinthu ziti zatsopano zomwe zakonzanso mawere pambuyo pa mastectomy?

• Opaleshoni ya pulasitiki. Mwambiri, azimayi omwe ali ndi lumpectomy kapena mastectomy pang'ono a khansa ya m'mawere koyambirira samamanganso. Komabe, kwa ena mwa amayiwa dotolo angagwiritse ntchito njira zopangira pulasitiki kuti asinthe bere panthawi yochitidwa khansa. Kuchita opaleshoni yoteteza m'mawere, yotchedwa oncoplastic upasuaji, itha kugwiritsa ntchito kukonzanso minofu yakomweko, kumanganso kudzera mu opaleshoni yochepetsa mawere, kapena kusamutsa ziphuphu. Zotsatira zakanthawi yayitali zamtunduwu wa opaleshoni ndizofanana ndi zomwe zimachitika pakuchita maopareshoni oyang'anira mawere (14).

• Autologous mafuta kumtengowo. Njira yatsopano yokonzanso mawere imaphatikizapo kusamutsa minofu yamafuta kuchokera mbali imodzi ya thupi (nthawi zambiri ntchafu, pamimba, kapena matako) kupita ku bere lokonzanso. Minofu yamafuta imakololedwa ndi liposuction, kutsukidwa, ndikumwa mowa kuti izilowetsedwa m'deralo. Kulumikiza mafuta kumagwiritsidwa ntchito makamaka kukonza zolakwika ndi ma asymmetries omwe amatha kuwoneka pambuyo pomanganso bere. Nthawi zina amagwiritsidwanso ntchito kukonzanso bere lonse. Ngakhale nkhawa yakhala ikufotokozedwa zakusowa kwamaphunziro azotsatira zazitali, njirayi imawonedwa ngati yotetezeka (1,6).

Zolemba Zosankhidwa

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Zowonjezera

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