Mhando / zamu / kuvaka-chokwadi-jira

Chipfuva Kuvakazve Mushure meMastectomy

Chii chinonzi kuvaka zamu?

Vakadzi vazhinji vane mastectomy - kuvhiya kubvisa zamu rese kurapa kana kudzivirira gomarara repazamu - vane mukana wekuva nechimiro chezamu rakabviswa rakavakwazve.

Vakadzi vanosarudza kuvakwa mazamu avo vane mikana yakawanda yekuti zvingaitwe sei. Mazamu anogona kuvakwazve achishandisa mapiritsi (saline kana silicone). Ivo vanogona zvakare kuvakwazve vachishandisa autologous tishu (ndokuti, tishu kubva kumwe kunhu mumuviri). Dzimwe nguva zvese zvinodyarwa uye zvinyama zvekuzvimiririra zvinoshandiswa kuvaka zvakare chipfuva.

Kuvhiya kwekumisazve mazamu kunogona kuitwa (kana kutanga) panguva yemastectomy (iyo inodaidzwa kunzi kuvaka patsva) kana inogona kuitwa mushure mekugadziriswa kwemastectomy uye kurapwa kwekenza yemazamu kwapera (iyo inonzi kunonoka kuvakazve) . Kunonoka kuvakwazve kunogona kuitika mwedzi kana kunyange makore mushure meye mastectomy.

Muchikamu chekupedzisira chekuvakazve zamu, munyatso uye areola zvinogona kugadzirwa patsva pazamu rakagadzirwazve, dai izvi zvisina kuchengetedzwa panguva yemastectomy.

Dzimwe nguva kuvhiyiwa kwemazamu kunosanganisira kuvhiya pane imwe, kana chibvumirano, zamu kuitira kuti mazamu maviri aenzane nehukuru uye chimiro.

Vanachiremba vanovhiya vanoshandisa sei maumbirwo kuvaka zvakare chipfuva chemukadzi?

Anodyara anoiswa pasi peganda kana chipfuva mhasuru zvichitevera mastectomy. (Mazhinji mastectomies anoitwa pachishandiswa nzira inonzi ganda-inodzivirira mastectomy, mune yakawanda yeganda reganda inochengetwa kuti ishandiswe mukumisazve zamu.)

Anodyara anowanzoiswa sechikamu chematanho maviri-maitiro.

• Muchikamu chekutanga, chiremba anovhiya anoisa mudziyo, unonzi kuchenesa nyama, pasi peganda rinosara mushure memastectomy kana pasi pechipfuva tsandanyama (1,2). Iyo expander inononoka kuzadzwa nesaline panguva yekushanya kwachiremba mushure mekuvhiyiwa.

• Muchikamu chechipiri, mushure mekunge chipfuva chechipfuva chazorora uye chakaporeswa zvakakwana, chinosimudzwa chinobviswa chotsiviwa nekuisirwa. Chipfuva chechifu chinowanzo gadzirira kudyara kwemwedzi miviri kusvika kumatanhatu mushure mekuzvarwa.

Mune zvimwe zviitiko, kuiswa kwacho kunogona kuiswa muchipfuva panguva yekuvhiyiwa kwakafanana neye mastectomy — ndiko kuti, chinhu chekusimudza nyama hachishandisirwe kugadzirira kudyara (3).

Vanachiremba vanovhiya vari kuramba vachishandisa zvinhu zvinonzi acellular dermal matrix senge scaffold kana "chipfuramabwe" kutsigira zvinowedzera zvinyama uye zvinoiswa. Acellular dermal matrix imhando yemeshoni inogadzirwa kubva kune yakapihwa yemunhu kana yenguruve ganda iro rakaomeswa uye rakagadziriswa kubvisa ese maseru kubvisa njodzi dzekurambwa uye hutachiona.

Vanachiremba vanovhiya vanoshandisa sei tishu kubva mumuviri wemukadzi kuvaka zvakare chipfuva?

Mukuzvigadzirira kwemasuru, chidimbu chemucheka chine ganda, mafuta, tsinga dzeropa, uye dzimwe nguva mhasuru inotorwa kubva kune imwe nzvimbo mumuviri wemukadzi uye inoshandiswa kuvaka zvakare chipfuva. Ichi chidimbu chetishu chinonzi chiuno.

Nzvimbo dzakasiyana mumuviri dzinogona kupa zviputi zvekuvakazve zamu. Mafuro anoshandiswa pakuvaka zamu kazhinji anouya kubva mudumbu kana kumashure. Nekudaro, izvo zvinogona zvakare kutorwa kubva pachidya kana magaro.

Zvichienderana nekwavo kwavanobva, kurovera kunogona kupomberwa kana kusununguka.

• Iine pedicled kurovera, iyo turu uye yakasungirirwa tsinga dzeropa dzinofambiswa pamwechete kuburikidza nemuviri kuenda kunzvimbo yezamu. Nekuti iro ropa rinopa kune iyo turu inoshandiswa kuvaka patsva yasara isina kusimba, tsinga dzeropa hadzifanirwe kubatanidzwazve kana nyama yacho yafambiswa.

• Nemahara emahara, munyama unochekwa wakasununguka kubva muropa rayo. Inofanira kusungirirwa kumidziyo mitsva yeropa munzvimbo yezamu, uchishandisa nzira inonzi microsurgery. Izvi zvinopa zamu rakavakwazve ropa.

Abdominal uye kumashure mapapiro anosanganisira:

• DIEP kurovera: Nyama inouya kubva mudumbu uye ine chete ganda, tsinga dzeropa, uye mafuta, isina musimba wepasi. Rudzi urwu rwembama irworwu rwemahara.

• Latissimus dorsi (LD) chikwapuro: Nyama inouya kubva pakati nepadivi rekuseri. Rudzi urwu rwembama rwuno pediched kana rwuchishandiswa pakuvaka zamu. (LD mapapiro anogona kushandiswa kune mamwe marudzi ekuvakazve futi.)

• SIEA flap (inonziwo SIEP flap): Tissue inouya kubva mudumbu senge mune DIEP kurova asi inosanganisira imwe seti yemidziyo yeropa. Izvo zvakare hazvibatanidzi kucheka kwemukati mesumbu uye ndeye yemahara kurovera. Rudzi urwu rwembama harusi sarudzo yevakadzi vazhinji nekuti mitsipa yeropa inodikanwa haina kukwana kana kuti haina.

• TRAM flap: Nyama inouya ichibva mudumbu repazasi senge mune DIEP kurova asi inosanganisira mhasuru. Inogona kuve pediced kana yemahara.

Mapapiro anotorwa kubva pachidya kana magaro anoshandiswa kune vakadzi vakambove nekuvhiyiwa kwepamuviri kwakanyanya kana vasina matumbu akakwana ekuvakisa zamu. Aya marudzi emapapiro emahara emahara. Nemapapiro aya kudyara kunowanzo shandiswa pamwe nekupa huwandu hwemazamu hwakakwana.

• IGAP kurovera: Nyama inouya kubva kumagaro uye ine chete ganda, tsinga dzeropa, uye mafuta.

• PAP kurova: Nyama, isina mhasuru, iyo inouya ichibva kumusoro kwepamusoro pechidya.

• SGAP kurovera: Nyama inouya kubva kumagaro senge iri IGAP kurova, asi inosanganisira imwe seti yemidziyo yeropa uye ine chete ganda, tsinga dzeropa, uye mafuta.

• TUG kurovera: Nyama, kusanganisira mhasuru, iyo inouya ichibva kumusoro kwepamusoro pehudyu.

Mune zvimwe zviitiko, iyo yekudyara uye ye autologous tishu inoshandiswa pamwechete. Semuenzaniso, zvinyama zvinogadziriswa zvinogona kushandiswa kuvhara kudyara kana pasina ganda rakaringana uye mhasuru yasara mushure memastectomy kubvumidza kuwedzera uye kushandiswa kweyakaisirwa (1,2).

Vanachiremba vanovaka sei munyatso uye areola?

Mushure mekunge chipfuva chapora kubva mukuvhiya kwekuvakazve uye chinzvimbo chechipfuva pamadziro echipfuva chave nenguva yekudzikama, chiremba anovhiya anogona kugadzirisazve munyatso uye areola. Kazhinji, iyo nyini nyowani inogadzirwa nekucheka nekufambisa zvidimbu zvidiki zveganda kubva pazamu rakagadzirwazve kuenda kunzvimbo yemazamu nekuzvigadzira kuita munyatso mutsva. Mwedzi mishoma mushure mekumisazve nyini, chiremba anovhiya anogona kugadzirisazve areola. Izvi zvinowanzoitwa uchishandisa tattoo inki. Nekudaro, mune dzimwe nguva, ganda rinonamirwa rinogona kutorwa kubva muchiuno kana mudumbu uye rakanamatira pazamu kugadzira areola panguva yekumisazve nyini (1).

Vamwe vakadzi vasina kuvhiyiwa nyini kuvaka vanogona kufunga kuwana chaiko mufananidzo wezamu rakagadzirwa pazamu rakagadzirwazve kubva kune tattoo muenzi uyo anonyanya kuita 3-D nyini yekunyora.

Mastectomy inochengetedza nyini yemukadzi uye areola, inonzi nipple-sparing mastectomy, inogona kuve sarudzo kune vamwe vakadzi, zvinoenderana nesaizi nenzvimbo yekenza yemazamu uye chimiro uye saizi yemazamu (4,5).

Ndezvipi zvinhu zvinokanganisa nguva yekuvakazve zamu?

Chinhu chimwe chinogona kukanganisa nguva yekuvakazve zamu ndechekuti mukadzi anozoda kurapwa nemwaranzi. Radiation kurapwa dzimwe nguva inogona kukonzera maronda ekurapa matambudziko kana hutachiona mumazamu akagadzirwazve, saka vamwe vakadzi vangasarudza kunonoka kuvakazve kusvikira kurapwa kwemwaranzi kwapera. Nekudaro, nekuda kwekuvandudzika kwemaitiro ekuvhiya uye emwaranzi, kuvaka patsva nekumisikidza kazhinji ichiri sarudzo kune vakadzi vanozoda kurapwa nemwaranzi. Autologous tishu yekuvaka zamu inowanzo chengeterwa mushure mekurapwa nemwaranzi, kuitira kuti chipfuva uye chipfuva chemadziro zvinyama zvinokuvadzwa nemwaranzi zvinokwanisa kutsiviwa nehutano hwakanaka kubva kune imwe nzvimbo mumuviri.

Chimwe chinhu mhando yekenza yemazamu. Vakadzi vane gomarara repazamu rinopisa vanowanzoda kuwedzera kubviswa kweganda Izvi zvinogona kuita kuti kuvaka patsva kuome zvakanyanya, saka zvinogona kukurudzirwa kuti kuvaka zvakare kunonoka kusvika mushure mekupedzisa kweadjuvant kurapwa.

Kunyangwe kana mukadzi ari mukwikwidzi wekuvakazve nekukurumidza, anogona kusarudza kunonoka kuvakazve. Semuenzaniso, vamwe vakadzi vanosarudza kusafunga nezverudzii rwekuvakazve kuti vave naro kusvikira vapora kubva kune yavo mastectomy uye inotevera adjuvant kurapwa. Vakadzi vanononoka kuvakwazve (kana kusarudza kusaita maitiro zvachose) vanogona kushandisa ekunze mazamu eprostheses, kana mafomu ezamu, kupa chitarisiko chemazamu.

Ndezvipi zvinhu zvinogona kukanganisa sarudzo yemaitiro ekuvakazve zamu?

Zvinhu zvinoverengeka zvinogona kukanganisa rudzi rwekuvhiya kwekuvakazve uko mukadzi anosarudza. Izvi zvinosanganisira saizi uye chimiro chezamu riri kuvakwazve, zera remukadzi uye hutano, nhoroondo yake yekuvhiya kwakapfuura, njodzi dzekuvhiya (semuenzaniso, nhoroondo yekuputa uye kufutisa), kuwanikwa kwezvinyama zvekuzvitakura, uye nzvimbo bundu muzamu (2,6). Vakadzi vakambove nekuvhiyiwa kwepamuviri kwepamberi vanogona kunge vasiri mukwikwidzi wekuvaka mudumbu zvakavakirwa pafap.

Mhando yega yega yekuvakazve ine zvinhu izvo mukadzi anofanira kufunga nezvazvo asati aita sarudzo. Zvimwe zvekufunga zvakajairika zvakanyorwa pazasi.

Kuvakazve neImplants

Kuvhiya uye kupora

• Ganda rakaringana uye mhasuru inofanirwa kusara mushure memastectomy kuvhara iyo yekudyara

• Maitiro mapfupi ekuvhiya pane ekuvakazve ane autologous tishu; kurasikirwa neropa kushoma

• Nguva yekudzoreredza inogona kuve ipfupi pane neayo autologous yekuvakazve

• Kushanya kwakawanda kwekutevera kunogona kudikanwa kuti kufutidze iwo wekuwedzera uye kuisa iyo yekuisa

Zvinogona kuitika

• Utachiona

• Kuunganidzwa kwemvura yakajeka kunokonzera kuwanda kana bundu (seroma) mukati mechipfuva chakavakwazve (7)

• Kubatanidza ropa (hematoma) mukati mechipfuva chakavakwazve

• Ropa rinovhara

• Kuwedzeredzwa kwekuisirwa (iyo yekudyara inopwanya kuburikidza neganda)

• Implant rupture (iyo inodyara inovhura uye saline kana silicone inodonhedza mumatunhu akakomberedza)

• Kuumbwa kwemavara akaomarara machena kutenderedza kuiswa (kunozivikanwa sechibvumirano)

• Kufutisa, chirwere cheshuga, uye kuputa kunogona kuwedzera mwero wezvinetso

• Inogona kuwedzera njodzi yekuvandudza mhando isingawanzoitika yemukenza yemasoja inonzi anaplastic hombe cell lymphoma (8,9)

Zvimwe zvekufunga

• Ngasave iri sarudzo yevarwere vakamboita radiation radiation pachipfuva

• Zvingave zvisina kukwana kune vakadzi vane mazamu akakura kwazvo

• Haigare kweupenyu hwese; kana mukadzi akaiswa marefu kwenguva yakareba, ndipo paanonyanya kuve nezvinetso uye anoda kuve nemidziyo yake

kubviswa kana kutsiviwa

• Silicone implants inogona kunzwa yakasarudzika kupfuura saline implants kune iyo inobata

• Chikafu neDrug Administration (FDA) inokurudzira kuti vakadzi vane michero yesilicone vanoongororwa nguva nenguva kuongororwa kweMRI kuti vaone kuputika kunogona "kunyarara"

Rumwe ruzivo nezve zvinodyarwa zvinogona kuwanikwa pane FDA's Breast Implants peji.

Kugadzirisazve neAtologous Tissue

Kuvhiya uye kupora

• Yakareba nzira yekuvhiya kupfuura yekuisa

• Yekutanga yekudzoreredza nguva inogona kuve yakareba kupfuura yekuisa

• Pedicled flap yekuvakazve kazhinji chiitiko chipfupi pane yemahara kurova rova ​​uye kazhinji inoda chipfupi chipatara

• Yemahara kurova-rova kuvaka ndekurefu, kwakanyanya hunyanzvi mashandiro achienzaniswa ne pedicled flap yekuvakazve iyo inoda kuti chiremba anovhiya ane ruzivo ne microsurgery kuisazve-kusunga mitsipa yeropa.

Zvinogona kuitika

• Necrosis (kufa) kwechinhu chakaendeswa

• Ropa rakagwamba rinogona kunge richiwanzoitika kazhinji pamwe nezvimwe zvipenga

• Marwadzo uye kushaya simba panzvimbo iyo yakatorwa michina yemupi

• Kufutisa, chirwere cheshuga, uye kuputa kunogona kuwedzera mwero wezvinetso

Zvimwe zvekufunga

• Inogona kupa yakasarudzika yemazamu chimiro pane inoiswa

• Inogona kunzwa yakapfava uye yakasununguka pakubata pane kudyara

• Inosiya ronda panzvimbo yaibviswa machira evanopa

• Inogona kushandiswa kutsiva munyama iyo yakakuvadzwa nemwaranzi kurapwa

Vakadzi vese vanoitwa mastectomy yekenza yemazamu vane ruzivo rwakasiyana-siyana rwechifuva chiveve uye kurasikirwa kwekunzwa (kunzwa) nekuti tsinga dzinopa kushushikana pazamu dzinochekwa kana nyama yemazamu yabviswa panguva yekuvhiyiwa. Nekudaro, mukadzi anogona kudzoreredza kumwe kunetseka sezvo tsinga dzakachekwa dzichikura nekumutsiridzwa, uye vanovhiya mazamu vachiramba vachiita kufambira mberi kwehunyanzvi uko kunogona kudzivirira kana kugadzirisa kukuvara kwemitsipa.

Chero chero rudzi rwekugadziriswa kwemazamu runogona kutadza kana kupora kukasaitika nemazvo. Muzviitiko izvi, kuiswa kana kurova pasi kunofanirwa kubviswa. Kana iyo yekumisazve kuvaka ikatadza, mukadzi anogona kazhinji kuve neyechipiri kuvaka zvakare kushandisa imwe nzira nzira.

Inishuwarenzi yehutano ichabhadhara kuvakwazve zamu here?

IWomen's Health uye Cancer Kodzero yeMutemo wa1998 (WHCRA) mutemo wezvematongerwo enyika unoda zvirongwa zvehutano zveboka uye makambani einishuwarenzi ehutano ayo anopa mastectomy kufukidza kuti abhadhare zvakare kuvhiya kwekuvakazve mushure memastectomy. Uku kufukidza kunofanirwa kusanganisira matanho ese ekuvakazve uye kuvhiya kuti uwane kuenzanisa pakati pemazamu, mazamu eprostheses, uye kurapwa kwezvinetso zvinokonzerwa nemastectomy, kusanganisira lymphedema. Rumwe ruzivo nezve WHCRA inowanikwa kubva kuDhipatimendi reVashandi uye maCentre eMedicare & Medicaid Services.

Mamwe marongero ehutano anotsigirwa nemasangano ezvitendero uye mamwe marongero ehutano ehurumende anogona kusunungurwa kubva kuWHCRA. Zvakare, WHCRA haishande kune Medicare neMedicaid. Zvisinei, Medicare inogona kuvhara kuvhiya kwemazamu pamwe nekunze kweprostheses (kusanganisira bhureki rekuvhiya) mushure mekurapa kunodiwa.

Medicaid mabhenefiti anosiyana nenyika; mukadzi anofanirwa kubata yake nyika Medicaid hofisi kuti uwane ruzivo rwekuti, uye kusvika papi, kuvakwa kwemazamu kwakavharwa.

Mukadzi anofunga nezvekuvakazve zamu angangoda kukurukura nezvezvinodhura uye inishuwarenzi yehutano kufukidza nachiremba wake nekambani yeinishuwarenzi asati asarudza kuvhiyiwa. Mamwe makambani einishuwarenzi anoda pfungwa yechipiri vasati vabvuma kubhadhara kuvhiyiwa.

Ndeapi mhando yekutevera-yekutarisira uye kugadzirisa kuri kudikanwa mushure mekugadziriswa kwemazamu?

Chero ipi mhando yekuvakazve inowedzera huwandu hwemhedzisiro mhedzisiro inogona kusangana nemukadzi kana ichienzaniswa neiyo inotevera mastectomy chete. Chikwata chemukadzi chekurapa chinomutarisa zvakanyanya kumatambudziko, mamwe acho anogona kuitika mwedzi kana kunyangwe makore mushure mekuvhiyiwa (1,2,10).

Vakadzi vane chero autologous tishu kana yekumisikidza-based kuvaka zvakare vanogona kubatsirwa kubva kuhutano hwepanyama kuvandudza kana kuchengetedza mafudzi mafambiro ekufamba kana kuvabatsira kupora kubva pautera hunowanikwa panzvimbo iyo yakapihwa tishu yemupi, senge kusimba kwemudumbu (11,12 ). Chiremba wepanyama anogona kubatsira mukadzi kushandisa maekisesaizi kuti awanezve simba, kujairira kune zvitsva zvinogumbuka, uye kuona nzira dzakachengeteka dzekuita zviitiko zvezuva nezuva.

Kugadziridzwa kwemazamu kunokanganisa kugona kuongorora kenza yemazamu ichidzokazve?

Zvidzidzo zvakaratidza kuti kuvakwa kwemazamu hakuwedzeri mikana yekenza yemazamu kudzoka kana kuita kuti zvinyanye kutarisa kudzokororwa nemammography (13).

Vakadzi vane zamu rimwe vakabviswa nemastectomy vacharamba vaine mammograms eimwe zamu. Vakadzi vane chirwere chekuchengetedza ganda kana avo vari panjodzi yakanyanya yekudzoka nekenza yemazamu vanogona kunge vane mammogramu ezamu rakavakwazve kana rikavakwazve vachishandisa zvinyama zvekuzvimiririra. Nekudaro, mammograms kazhinji haaitwe pamazamu ayo anovakwazve aine kudyara mushure memastectomy.

Mukadzi ane zamu anodyara anofanirwa kutaurira radiology technician nezve iye anodyara asati ave nemammogram. Maitiro akakosha anogona kudikanwa kusimudzira kunyatso kweiyo mammogram uye kudzivirira kukuvadza kudyara.

Rumwe ruzivo nezve mammograms anogona kuwanikwa muNCI chokwadi sheet Mammograms.

Ndezvipi zvimwe zviitiko zvitsva mukugadziriswa kwemazamu mushure memastectomy?

• Kuvhiya kweOncoplastic. Muzhinji, vakadzi vane lumpectomy kana chidimbu chemastectomy yekenza-yekutanga gomarara remazamu havana kuvaka zvakare. Nekudaro, kune vamwe vevakadzi ava chiremba anovhiya anogona kushandisa nzira dzekuvhiya dzeplastiki kuumbazve chipfuva panguva yekuvhiyiwa gomarara. Rudzi urwu rwekuvhiya-kuchengetedza zamu, kunodaidzwa kuti oncoplastic kuvhiyiwa, kunogona kushandisa marongero emunharaunda, kuvaka patsva kuburikidza nekuvhiya kwekudzora zamu, kana kuendesa kwembama. Yakareba-mhedzisiro mhedzisiro yerudzi urwu rwekuvhiya inofananidzwa neiyo yeyakajairika ekuchengetedza zamu-kuchengetedza kuvhiya (14).

• Autologous mafuta kubatanidza. Rudzi rutsva rwemaitiro ekumisazve zamu runosanganisira kuendesa kwemafuta matema kubva kune chimwe chikamu chemuviri (kazhinji zvidya, dumbu, kana magaro) kuenda kuchipfuva chakavakwazve. Iyo nyama yemafuta inokohwewa ne liposuction, yakashambidzwa, uye nekumwiwa kuitira kuti igone kubayiwa munzvimbo yekufarira. Mafuta kubatanidza anonyanya kushandiswa kugadzirisa zvakashata uye maasymmetries anogona kuoneka mushure mekugadziriswa kwemazamu. Iyo zvakare dzimwe nguva inoshandiswa kugadzirisa zvakare iro zamu rese. Kunyangwe kunetsekana kwakasimudzwa pamusoro pekushaikwa kwenguva refu mhedzisiro yezvidzidzo, maitiro aya anoonekwa seakachengeteka (1,6).

Sarudzo Referensi

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Zvakafanana Zviwanikwa

Gomarara repazamu - Patient Version

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Mammograms

Kuvhiya Kuderedza Njodzi yeCancer yeCancer

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