Izinhlobo / isifuba / iphepha lokwakha kabusha

Ukwakhiwa Kwamabele Ngemuva Kwe-Mastectomy

Kuyini ukwakhiwa kabusha kwamabele?

Abesifazane abaningi abane-mastectomy — ukuhlinzwa kukhishwe lonke isifuba ukwelapha noma ukuvimbela umdlavuza webele — banenketho yokuba nokwakheka kabusha kwesifuba esisusiwe.

Abesifazane abakhetha ukuthi amabele abo akhe kabusha banezinketho eziningi zokuthi kungenziwa kanjani. Amabele angakhiwa kabusha kusetshenziswa okufakelwa (usawoti noma abicah). Zingabuye zakhiwe kabusha kusetshenziswa izicubu ze-autologous (okungukuthi, izicubu ezivela kwenye indawo emzimbeni). Kwesinye isikhathi kusetshenziswa zombili izimila nezicubu zomzimba ukwakha ibele.

Ukuhlinzwa kokwakha kabusha amabele kungenziwa (noma kuqalwe) ngesikhathi se-mastectomy (okubizwa ngokuthi ukwakhiwa kabusha ngokushesha) noma kungenziwa ngemuva kokuthi ukwelashwa kwe-mastectomy selulame nokwelashwa komdlavuza webele kuqediwe (okubizwa ngokuthi ukwakhiwa kabusha kokubambezeleka) . Ukwakhiwa kabusha okubambezelekile kungenzeka izinyanga noma ngisho neminyaka ngemuva kwe-mastectomy.

Esigabeni sokugcina sokwakhiwa kabusha kwesifuba, ingono ne-areola kungaphinde kudalwe ebeleni elakhiwe kabusha, uma lokhu kungalondolozwanga ngesikhathi se-mastectomy.

Kwesinye isikhathi ukuhlinzwa kokwakhiwa kabusha kwamabele kufaka phakathi ukuhlinzwa kolunye, noma okuvundlile, isifuba ukuze amabele womabili afane ngosayizi nokuma kwawo.

Ngabe odokotela abahlinzayo bakusebenzisa kanjani ukufakelwa kabusha ibele lowesifazane?

Izimila zifakwa ngaphansi kwesikhumba noma imisipha yesifuba kulandela i-mastectomy. (Iningi lama-mastectomies lenziwa kusetshenziswa inqubo ebizwa nge-skin-sparing mastectomy, lapho kugcinwa khona isikhumba sesifuba esiningi ukuze sisetshenziswe ekwakheni kabusha isifuba.)

Izimila zivame ukubekwa njengengxenye yenqubo yezinyathelo ezimbili.

• Esigabeni sokuqala, udokotela ohlinzayo ubeka ithuluzi, elibizwa ngokuthi i-expander expander, ngaphansi kwesikhumba esisele ngemuva kwe-mastectomy noma ngaphansi kwesicubu sesifuba (1,2). I-expander igcwaliswa kancane ngosawoti ngesikhathi uvakashelwa udokotela ngezikhathi ezithile ngemuva kokuhlinzwa.

• Esigabeni sesibili, ngemuva kokuthi izicubu zesifuba seziphumule futhi selulame ngokwanele, i-expander iyasuswa bese kufakwa okufakelwe. Izicubu zesifuba zivame ukulungela ukufakwa ezinyangeni ezi-2 kuya kwezi-6 ngemuva kwe-mastectomy.

Kwezinye izimo, ukufakelwa kungafakwa esifubeni ngesikhathi sokuhlinzwa okufanayo ne-mastectomy — okusho ukuthi, ukunwetshwa kwezicubu akusetshenziselwa ukulungiselela ukufakelwa (3).

Odokotela abahlinzayo baya ngokuya basebenzise okokusebenza okubizwa nge-acellular dermal matrix njengohlobo lwescaffold noma “indwayimane” ukuxhasa izikhulisi zezicubu kanye nokufakelwa. I-Acellular dermal matrix wuhlobo lwe-mesh olwenziwe ngesikhumba somuntu noma yengulube esinikelwe esenziwe inzalo futhi saqhutshwa ukuze kususwe wonke amaseli ukuqeda ubungozi bokwaliwa nokutheleleka.

Odokotela abahlinzayo bazisebenzisa kanjani izicubu zomzimba wowesifazane uqobo ukwakha ibele?

Ekwakhiweni kabusha kwezicubu zomzimba, ucezu lwesicubu esiqukethe isikhumba, amafutha, imithambo yegazi, kwesinye isikhathi isicubu sithathwa kwenye indawo emzimbeni wowesifazane futhi sisetshenziselwe ukwakha kabusha isifuba. Le ngcezu yezicubu ibizwa ngokuthi i-flap.

Amasayithi ahlukene emzimbeni anganikeza izikhala zokuvuselelwa kwamabele. Izindunduma ezisetshenziselwa ukwakhiwa kabusha kwamabele zivame ukuvela esiswini noma emuva. Kodwa-ke, zingathathwa nasethangeni noma ezinqeni.

Ngokuya ngomthombo wabo, ukushaywa kungafakwa ipediced noma mahhala.

• Ngokuchaphazeleka okuhanjisiwe, izicubu nemithambo yegazi enamathiselwe ihanjiswa ndawonye ngomzimba iye endaweni yebele. Ngenxa yokuthi ukunikezwa kwegazi ezicutshini ezisetshenziselwa ukwakhiwa kabusha kushiywe kunganyakazi, imithambo yegazi ayidingi ukuphinde ixhunywe lapho isicubu sesithuthwa.

• Ngezimpama zamahhala, izicubu ziyasikwa zingabi khona egazini lazo. Kumele inamathiselwe emithanjeni yegazi emisha endaweni yebele, kusetshenziswa inqubo ebizwa nge-microsurgery. Lokhu kunikeza isifuba esakhiwe kabusha ukunikezwa kwegazi.

Izimpawu zesisu nangemuva zifaka:

• I-DIEP flap: Izicubu zivela esiswini futhi ziqukethe kuphela isikhumba, imithambo yegazi, namafutha, ngaphandle kwesisipha esingaphansi. Lolu hlobo lwe-flap luyi-flap yamahhala.

• I-flap ye-Latissimus dorsi (LD): Izicubu zivela maphakathi nohlangothi lwangemuva. Lolu hlobo lwe-flap lubethelwa lapho lusetshenziselwa ukwakhiwa kabusha kwamabele. (Ama-LD flaps angasetshenziselwa ezinye izinhlobo zokwakhiwa kabusha.)

• I-SIEA flap (ebizwa nangokuthi i-SIEP flap): Izicubu zivela esiswini njengakwi-DIEP flap kepha zifaka iqoqo elithile lemithambo yegazi. Futhi akubandakanyi ukusika imisipha yesisu futhi kuyisikhala esivulekile. Lolu hlobo lwechopho aluyona inketho kwabesifazane abaningi ngoba imithambo yegazi edingekayo ayenele noma ayikho.

• I-TRAM flap: Izicubu zivela esiswini esingezansi njengaku-DIEP flap kepha kufaka nemisipha. Kungafakwa ipediced noma mahhala.

Izindunduma ezithathwe ethangeni noma ezinqeni zisetshenziselwa abesifazane abake bahlinzwa kakhulu esiswini noma abangenazo izicubu ezanele zesisu sokwakha kabusha ibele. Lezi zinhlobo zezingqimba zingama-flaps amahhala. Ngala maflaps ukufakelwa kwesinye isikhathi kusetshenziswa futhi ukuhlinzeka ivolumu yamabele eyanele.

• I-flap ye-IGAP: Izicubu zivela ezinqeni futhi ziqukethe kuphela isikhumba, imithambo yegazi, namafutha.

• I-PAP flap: Izicubu, ngaphandle kwemisipha, ezivela ethangeni elingaphakathi elingaphezulu.

• I-SGAP flap: Izicubu zivela ezinqeni njengasekuphangweni kwe-IGAP, kepha kufaka phakathi isethi ehlukile yemithambo yegazi futhi iqukethe isikhumba kuphela, imithambo yegazi, namafutha.

• I-TUG flap: Izicubu, kufaka phakathi imisipha, evela ethangeni elingaphakathi elingaphezulu.

Kwezinye izimo, izicubu zokufakelwa kanye nezomzimba zisetshenziswa ndawonye. Isibonelo, izicubu ezizenzekelayo zingasetshenziselwa ukumboza ukufakelwa lapho singekho isikhumba esanele nemisipha esisele ngemuva kwe-mastectomy ukuvumela ukunwetshwa nokusetshenziswa kokufakwa (1,2).

Odokotela abahlinzayo bayakha kanjani ingono ne-areola?

Ngemuva kokuphola kwesifuba ekuhlinzweni kokwakhiwa kabusha kanye nokuma kwendunduma yesifuba odongeni lwesifuba kube nesikhathi sokuzinza, udokotela ohlinzayo angayakha kabusha ingono ne-areola. Imvamisa, ingono entsha idalwa ngokusika nokuhambisa izingcezu zesikhumba ezincane ukusuka ebeleni elakhiwe kabusha ziye engosini yengono bese uzifaka kwingono entsha. Ezinyangeni ezimbalwa ngemuva kokwakhiwa kabusha kwezingono, udokotela ohlinzayo angayakha kabusha i-areola. Lokhu kuvame ukwenziwa kusetshenziswa inki ye-tattoo. Kodwa-ke, kwezinye izimo, ukufakwa kwesikhumba kungathathwa emgodini noma esiswini bese kunamathiselwa esifubeni ukwenza i-areola ngesikhathi sokuvuselelwa kwezingono (1).

Abanye besifazane abangenakho ukwakhiwa kabusha kwezingono bangacabanga ukuthola isithombe esingokoqobo sengono eyakhiwe esifubeni esakhiwe kabusha esivela kumdwebi we-tattoo ogxile ekubhaliseni ingono ka-3-D.

I-mastectomy egcina ingono yowesifazane kanye ne-areola, ebizwa nge-nipple-sparing mastectomy, ingaba yindlela abanye besifazane, kuya ngosayizi nendawo yomdlavuza webele kanye nokuma nosayizi wamabele (4,5).

Yiziphi izinto ezingathinta isikhathi sokwakhiwa kabusha kwamabele?

Isici esisodwa esingathinta isikhathi sokwakhiwa kabusha kwamabele ukuthi ngabe owesifazane uzodinga yini ukwelashwa ngemisebe. Ukwelashwa ngemisebe kwesinye isikhathi kungadala izinkinga zokuphulukiswa kwesilonda noma izifo ezifubeni ezakhiwe kabusha, ngakho-ke abanye besifazane bangakhetha ukubambezela ukwakhiwa kabusha kuze kube yilapho ukwelashwa ngemisebe sekuphelile. Kodwa-ke, ngenxa yokuthuthuka kwezindlela zokuhlinza nemisebe, ukwakhiwa kabusha ngokushesha kokufakelwa imvamisa kuyindlela yabesifazane abazodinga ukwelashwa ngemisebe. Ukwakhiwa kabusha kwesifuba se-Autologous kuvame ukubekelwa ukwelashwa ngemisebe, ukuze izicubu zodonga lwesifuba nesifuba ezilinyazwe yimisebe zingashintshwa ngezicubu ezinempilo ezivela kwenye indawo emzimbeni.

Esinye isici uhlobo lomdlavuza webele. Abesifazane abanomdlavuza webele wokuvuvukala ngokuvamile badinga ukususwa okubanzi kwesikhumba. Lokhu kungenza ukwakhiwa kabusha kube nzima kakhulu, ngakho-ke kunganconywa ukuthi ukwakhiwa kabusha kubambezeleke kuze kube ngemuva kokuphothula ukwelashwa kwe-adjuvant.

Noma owesifazane engabandelwa ukwakhiwa kabusha ngokushesha, angakhetha ukwakhiwa kokubambezeleka. Isibonelo, abanye besifazane bakhetha ukungacabangi ukuthi hlobo luni lokwakhiwa kabusha okufanele babe nalo kuze kube yilapho sebethole ukwelashwa kwabo kwe-mastectomy kanye nokwelashwa okulandelayo kwe-adjuvant. Abesifazane ababambezela ukwakhiwa kabusha (noma bakhethe ukungayenzi nhlobo inqubo) bangasebenzisa ama-prostheses angaphandle, noma amafomu amabele, ukubukeka kwamabele.

Yiziphi izinto ezingathinta ukukhetha kwendlela yokwakha kabusha amabele?

Izici eziningana zingaba nomthelela ohlotsheni lokuhlinzwa okwakhiwa kabusha ngumfazi. Lokhu kufaka usayizi nokuma kwesifuba esizokwakhiwa kabusha, iminyaka nempilo yowesifazane, umlando wakhe wokuhlinzwa kwangaphambilini, izinto ezinobungozi zokuhlinzwa (ngokwesibonelo, umlando wokubhema nokukhuluphala), ukutholakala kwezicubu zomzimba, kanye nendawo isimila esifubeni (2,6). Abesifazane asebeke bahlinzwa isisu esikhathini esedlule kungenzeka bangabi ukhetho lokuvuselelwa kabusha kwe-flap esiswini.

Uhlobo ngalunye lokwakhiwa kabusha lunezici owesifazane okufanele acabange ngazo ngaphambi kokwenza isinqumo. Okunye kokucatshangelwa okuvamile kubhalwe ngezansi.

Ukwakhiwa kabusha ngezimila

Ukuhlinzwa nokululama

• Isikhumba kanye nemisipha eyanele kufanele ihlale ngemuva kwe-mastectomy ukumboza ukufakelwa

• Inqubo emfushane yokuhlinza kunokwakhiwa kabusha ngezicubu zomzimba; ukulahleka kwegazi okuncane

• Isikhathi sokutakula singaba sifushane kunokwakhiwa kabusha kwe-autologous

• Ukuvakasha okuningi kokulandela kungadingeka ukuze kufuthwe isandiso bese ufaka okufakelwayo

Izinkinga ezingenzeka

• Ukutheleleka

• Ukuqoqwa koketshezi olucacile obangela isisindo noma isigaxa (seroma) ngaphakathi kwesifuba esakhiwe kabusha (7)

• Ukuqoqwa kwegazi (hematoma) ngaphakathi kwesifuba esakhiwe kabusha

• Amahlule egazi

• Ukukhishwa kokufakwa (ukufakelwa kugqashuka esikhunjeni)

• Ukuqhekeka kokutshala (ukufakelwa kuvuleke kuvuleke usawoti noma u-silicone ezicutshini ezizungezile)

• Ukwakheka kwezicubu ezibomvu ezinzima ezungeze ukufakelwa (okwaziwa njengesivumelwano)

• Ukukhuluphala ngokweqile, isifo sikashukela nokubhema kungakhuphula izinga lezinkinga

• Ingozi ekhulayo yokuthuthukisa uhlobo olungavamile kakhulu lomdlavuza womzimba obizwa nge-anaplastic large cell lymphoma (8,9)

Okunye ukucatshangelwa

• Kungenzeka kungabi inketho yeziguli ezake zathola ukwelashwa ngemisebe esifubeni

• Kungenzeka kunganele abesifazane abanamabele amakhulu kakhulu

• Ngeke ihlale impilo yonke; uma owesifazane ehlala nokufakelwa isikhathi eside, maningi amathuba okuthi abe nezinkinga futhi adinge ukufakelwa

isusiwe noma yafakwa esikhundleni

• Ukufakwa kwe-silicone kungazizwa kungokwemvelo kakhulu kunezimila ezinosawoti ekuthinteni

• Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kuncoma ukuthi abesifazane abanezilimo ze-silicone bahlolelwe i-MRI ngezikhathi ezithile ukuze kutholakale ukuqhekeka "kokuthula" okungafakelwa

Imininingwane engaphezulu mayelana nokufakwa kungatholakala ekhasini le-FDA's Breast Implants.

Ukwakhiwa kabusha nge-Autologous Tissue

Ukuhlinzwa nokululama

• Inqubo ende yokuhlinzwa kunaleyo yokufakelwa

• Isikhathi sokuqala sokululama singase sibe side kunokufakwa

• Ukwakhiwa kabusha kwe-flap nge-pedicled imvamisa kungumsebenzi omfushane kunokwakhiwa kabusha kwe-flap yamahhala futhi imvamisa kudinga ukulaliswa esibhedlela okufushane

• Ukwakhiwa kabusha kwe-flap kwamahhala kungumsebenzi omude, osebenza ngobuchwepheshe obukhulu uma kuqhathaniswa nokwakhiwa kabusha kwe-flap okwenziwe nge-pedicled okudinga udokotela ohlinzayo onolwazi nge-microsurgery ukufaka kabusha imithambo yegazi

Izinkinga ezingenzeka

• I-Necrosis (ukufa) kwezicubu ezidlulisiwe

• Amahlule egazi angahle avame kakhulu ngemithombo ethile ye-flap

• Ubuhlungu nobuthakathaka endaweni lapho izicubu zabanikeli zithathwe khona

• Ukukhuluphala ngokweqile, isifo sikashukela nokubhema kungakhuphula izinga lezinkinga

Okunye ukucatshangelwa

• Kunganikeza ukwakheka kwesifuba okungokwemvelo kunokufakwa

• Kwangathi ungazizwa uthambile futhi ungokwemvelo ekuthintweni kunezinto ezifakiwe

• Ishiya isibazi esizeni lapho kwathathwa khona izicubu zabanikeli

• Ingasetshenziselwa ukufaka esikhundleni sezicubu ezilinyazwe ukwelashwa ngemisebe

Bonke abesifazane abathola i-mastectomy yomdlavuza webele bahlangabezana namazinga ahlukahlukene endikindiki ebeleni nokulahlekelwa umuzwa (ukuzwa) ngoba izinzwa ezinikeza ukuzwa ebeleni ziyasikwa lapho izicubu zesifuba zisuswa ngesikhathi sokuhlinzwa. Kodwa-ke, owesifazane angaphinde athole imizwa ethile njengoba izinzwa ezinqunyiwe zikhula futhi zivuseleleka, futhi odokotela abahlinzayo besifuba bayaqhubeka nokwenza intuthuko yezobuchwepheshe engavikela noma yokulungisa ukulimala kwezinzwa.

Noma yiluphi uhlobo lokwakhiwa kabusha kwamabele lungahluleka uma ukwelashwa kungenzeki kahle. Kulezi zimo, ukufakelwa noma i-flap kuzofanela kususwe. Uma ukwakhiwa kabusha kokufakelwa kwehluleka, owesifazane angavame ukwakhiwa kabusha kwesibili esebenzisa enye indlela.

Ngabe umshuwalense wezempilo uzokhokha ukwakhiwa kabusha kwamabele?

I-Women's Health and Cancer Rights Act ka-1998 (WHCRA) umthetho kahulumeni odinga izinhlelo zezempilo zeqembu kanye nezinkampani zomshuwalense wezempilo ezinikeza ukumbozwa kwe-mastectomy ukukhokhela nokuhlinzwa okwakhiwa kabusha ngemuva kwe-mastectomy. Lokhu kufakwa kumele kufake zonke izigaba zokwakhiwa kabusha nokuhlinzwa ukuze kuzuzwe ukulingana phakathi kwamabele, okufakelwa amabele, kanye nokwelashwa kwezinkinga ezibangelwa i-mastectomy, kufaka phakathi i-lymphedema. Imininingwane engaphezulu nge-WHCRA iyatholakala kuMnyango Wezabasebenzi kanye naseCentre for Medicare & Medicaid Services.

Ezinye izinhlelo zezempilo ezixhaswe izinhlangano zezenkolo kanye nezinhlelo ezithile zikahulumeni zezempilo zingakhishwa ku-WHCRA. Futhi, i-WHCRA ayisebenzi ku-Medicare naseMedicaid. Kodwa-ke, iMedicare ingafaka ukumhlinzekwa kokwakhiwa kabusha kwesifuba kanye nokufakelwa kwamabele kwangaphandle (kufaka phakathi ubhodisi wangemva kokuhlinzwa) ngemuva kwe-mastectomy edingekayo kwezokwelapha.

Izinzuzo zemedicaid ziyahlukahluka ngezwe Owesifazane kufanele axhumane nehhovisi lakhe le-Medicaid ukuthola imininingwane yokuthi ngabe kuvuselelwa kabusha amabele kangakanani, futhi kangakanani.

Owesifazane ocabanga ukwakhiwa kabusha kwamabele angafuna ukuxoxa ngezindleko nokutholakala komshuwalense wezempilo nodokotela wakhe nenkampani yomshuwalense ngaphambi kokukhetha ukuhlinzwa. Ezinye izinkampani zomshuwalense zidinga umbono wesibili ngaphambi kokuthi zivume ukukhokhela ukuhlinzwa.

Uhlobo luni lokunakekelwa okulandelwayo nokuvuselelwa okudingekayo ngemuva kokwakhiwa kabusha kwamabele?

Noma yiluphi uhlobo lokwakhiwa kabusha lwandisa inani lemiphumela emibi owesifazane angaba nayo uma iqhathaniswa naleyo engemva kwe-mastectomy yedwa. Ithimba lowesifazane lowesifazane lizombhekisisa ukuze abhekane nezinkinga, ezinye zazo ezingenzeka izinyanga noma ngisho neminyaka ngemuva kokuhlinzwa (1,2,10).

Abesifazane abanezicubu ze-autologous noma ukwakhiwa kabusha okugxilisiwe bangazuza ekwelashweni ngokomzimba ukwenza ngcono noma ukugcina uhla lokunyakaza noma babasize balulame ebuthakathakeni obutholwe kusayithi lapho izicubu zomnikeli zithathwe khona, njengobuthakathaka besisu (11,12) ). Udokotela ongokomzimba angasiza owesifazane ukuthi asebenzise izivivinyo ukuze athole amandla kabusha, ajwayele imikhawulo emisha yomzimba, futhi athole izindlela eziphephe kakhulu zokwenza imisebenzi yansuku zonke.

Ngabe ukwakhiwa kabusha kwamabele kuthinta ikhono lokuhlola ukuphindeka komdlavuza webele?

Ucwaningo lukhombisile ukuthi ukwakhiwa kabusha kwamabele akwenyusi amathuba okuba umdlavuza webele ubuye noma kwenze kube nzima ukubheka ukuphindeka nge-mammography (13).

Abesifazane abasuswe ebeleni elilodwa nge-mastectomy basazoba nama-mammograms wesinye isifuba. Abesifazane abake baba ne-mastectomy yokuvikela isikhumba noma abasengozini enkulu yokuphindeka komdlavuza webele bangaba namamamitha wesifuba esakhiwe kabusha uma sakhiwa kabusha kusetshenziswa izicubu ezizenzekelayo. Kodwa-ke, ama-mammograms ngokuvamile awenziwa emabeleni akhiwa kabusha ngokufakelwa ngemuva kwe-mastectomy.

Owesifazane onesimila sebele kufanele atshele uchwepheshe we-radiology ngokufakwa kwakhe ngaphambi kokuba enze i-mammogram. Izinqubo ezikhethekile zingadingeka ukwenza ngcono ukunemba kwe-mammogram nokugwema ukulimaza okufakelwayo.

Imininingwane engaphezulu ngama-mammograms ingatholakala ku-NCI sheet sheet Mammograms.

Yikuphi okunye okusha okwenziwayo ekwakhiweni kabusha kwamabele ngemuva kwe-mastectomy?

• Ukuhlinzwa kwe-Oncoplastic. Ngokuvamile, abesifazane abane-lumpectomy noma i-mastectomy engaphelele yomdlavuza webele webanga lokuqala abanakho ukwakhiwa kabusha. Kodwa-ke, kwabanye balaba besifazane udokotela ohlinzayo angasebenzisa izindlela zokuhlinza ngepulasitiki ukubumba kabusha isifuba ngesikhathi sokuhlinzwa komdlavuza. Lolu hlobo lokuhlinzwa olonga ibele, olubizwa nge-oncoplastic surgery, lungasebenzisa ukuhlelwa kabusha kwezicubu zasendaweni, ukwakhiwa kabusha ngokuhlinzwa kokuncishiswa kwebele, noma ukudluliswa kwezicubu zomzimba. Imiphumela yesikhathi eside yalolu hlobo lokuhlinzwa ifana naleyo yokuhlinzwa okujwayelekile okugcina amabele (14).

• Ukuxhunyelelwa kwamafutha e-Autologous. Uhlobo olusha lwendlela yokwakha kabusha amabele lubandakanya ukudluliswa kwezicubu ezinamafutha zisuka engxenyeni eyodwa yomzimba (imvamisa amathanga, isisu, noma izinqe) ziye esifubeni esakhiwe kabusha. Izicubu ezinonile zivunwa nge-liposuction, zigezwe, futhi ziphuziswe ukuze zikwazi ukujova endaweni oyithandayo. Ukuhlanganiswa kwamafutha kusetshenziselwa ukulungisa ukukhubazeka kanye nama-asymmetries angavela ngemuva kokwakhiwa kabusha kwamabele. Futhi kwesinye isikhathi kusetshenziselwa ukwakha kabusha lonke ibele. Yize kuphakanyisiwe ukukhathazeka ngokungabi bikho kwezifundo zemiphumela yesikhathi eside, le ndlela ithathwa njengephephile (1,6).

Izinkomba ezikhethiwe

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Izinsiza Ezihlobene

Umdlavuza Webele — Inguqulo Yesineke

Ukubhekana Phambili: Impilo Ngemuva Kokwelashwa Komdlavuza

AmaMammograms

Ukuhlinzwa Ukunciphisa Ubungozi Bomdlavuza Webele

Izinketho Zokuhlinzwa Kwabesifazane abane-DCIS noma Umdlavuza Webele