Ukwakhiwa kwesisu kusemgangathweni kwengqondo yabasetyhini abaninzi xa beyazi ukuba kufuneka bafumane i- mastectomy . Phezulu kokujongana noxinzelelo lwe-diagnostic yomhlaza, abafazi abajongene nomzabalazo we-mastectomy ngolwazi lokuba imizimba yabo ayisoze yafana. Bangakhathazeka ngokukhanga kwabo kunye nokuziphatha ngokwesini emva kokuhlinzwa, kwaye bajonge ukuvuselelwa kwebele njengendlela yokujongana nezo nkxalabo.
Ingcamango yokuvuselelwa kwebele ingaba yinto enqwenelekayo kuba ibonakala ngathi yindlela yokujonga kwaye ivakale "yesiqhelo" kwakhona. Kusenokwenzeka ukuba uqalise ukuhlinzwa ngokutsha ngenkqubela ephantsi kwe-anesthesia enikezelwe ukuba i-mastectomy. Kodwa kuthekani ukuba kufuneka ufumane umbane kunye ne- chemotherapy emva kokuvuselelwa kwesifuba sakho? Ngaba ezo zonyango ziya kuwonakalisa iziphumo onethemba lokuzifezekisa?
Kude nje kwiminyaka embalwa edlulileyo, uninzi lweengcali lucetyiswa malunga nokuvuselelwa kwebele ngaphambi kokuba imisebe. Kodwa izifundo zakutshanje, ezibandakanya enye ngeFood Chase Cancer Centre eFiladelphia kunye nesinye iSibhedlele seYunivesithi yaseCleveland, sigqibe ukuba akukho sizathu sokuyibeka. Nangona kunjalo, izikhululo zezokwelapha azivumelani nokokuba izigulana zimele zilinde okanye ziqhubeke.
Nasiphi na isigulane esicinga ukuvuselelwa kwebele, kufuneka idibanise ingcali yokuvuselela isifuba (kunye ne-oncologist yakhe) kungekudala emva kokuxilongwa komhlaza njengokuba kunokwenzeka ukucacisa indlela yakhe yokusebenza.
I-Case yokuhamba phambili ne-Breast Reconstruction
Kukho iintlobo ezininzi zokuvuselelwa kwangaphambili kwebele. Ininzi yokwakhiwa kwesifuba idinga ukuhlinzwa okungaphezulu kweyodwa, kwaye ukuyiqala ngelixa iphantsi kwe-anesthesia ye-mastectomy kuthetha ukuba inkqubo iyaqhubeka phambi kokuba isigulane sivuke.
I-mastectomy ekhumba isikhumba, eshiya isifuba "isikhwama," ikwacetyiswa kuphela ukuba ukulungiswa kwakhona kuya kusondela.
Njengomthetho oqhelekileyo, abafazi abanomdlavuza wesibeleko (iintsholongwane ezincinci ezingazange zisasaze kwii-lymph node okanye ukuqhubela phambili kwazo zigcinwe kwiinkalo ezingaphantsi kwinqanaba elifana nebele elichaphazelekayo) lingaqhubeka nokuvuselelwa. Ngaphandle kokuba kubonakala ukuba isigulane sidinga i-radiation emva kwe-mastectomy ngenxa yomdlavuza omkhulu kumbele okanye umhlaza ocacileyo kwi-armpit, uDkt. Christy Russell, isifuba se-oncologist kwiYunivesithi yase-Southern California, ukhetha ukuba ukulungiswa kwakhona kwenziwa ngexesha le-mastectomy.
Nangona kunjalo, kunokuba kunzima ukufumanisa ukuba ngaba kuya kufuneka imirhumo kwezinye izigulane ngaphambi kokuba ziphathwe. Ngokutsho kukaDkt. Russell, abaninzi ababelethayo bebele bayakuthanda ukuba isigulane siphumelele ngokutsha, kungekhona sokulibaziseka ukuba sigweme ukuhlinzwa okwesibini kunye ne-anesthesia.
Iingxaki ezinokwenzeka ezinokuthi zonyango, izimonyo okanye zombini. Ziyakwazi ukuquka ukubunjwa kwezicubu zesibindi sesifuba, ukuqiniswa kwezicubu, ukusuleleka okanye i-necrosis (ukufa) kwezinye izicubu ezinamafutha, ezinokubangela izilwanyana. Ukuba kuninzi, iingxaki zingadinga ukuhlinzwa ngokutsha ukulungisa okanye ukulungiswa kwakhona.
Ucwaningo olutsha luye lwagqiba ukuba xa i-radiation ilandela ukuvuselelwa kwebele, akukho zinyuka kwiinkcenkcesho ezincinci okanye ezinkulu. Olunye uphando lufumene ukuba i-75% yezigulane ezazivuselelwe izibeleko ngaphambi kokuba i-radiation zichaze isiphumo sezityalo ezilungileyo, ezifanayo okanye ezingcono kunokuba ukwaneliswa kwezigulane ezingenayo imitha.
Ukuhlinzwa ngokutsha kwimeko ngexesha le-mastectomy liqheleke kakhulu kwiziko lezonyango ezahlukeneyo ezinama-oncologists kunye nabagqirha beplastiki abasebenza kunye kwiziko elifanayo.
Icala lokulinda ukubuyiswa kwesisu
I-American Cancer Society ichaza ukuba oogqirha abaninzi bancomela ukulibaziseka ukulungiswa kwakhona kwabo baziyo ukuba baya kuba ne-radiation, malunga nesiqingatha sazo zonke izigulane.
Ekuhambeni kwexesha, i-radiation inokuchaphazela ngonaphakade i-pigment, i-texture, kunye ne-elasticity yesikhumba, enokuchaphazela ukubonakala kwamabele.
Abasetyhini abaziyo ukuba banomhlaza wesibeleko ophakathi okanye ophezulu (abo abanezikhumba ezingaphezu kweesentimitha ezi-5 kunye ne-lymph nodes ezichaphazelekayo) bacetyiswa ukuba balinde iinyanga ezintandathu ukuya kunyaka ukuya kutsho unyango lugqityiwe. Labo abanomdlavuza ophezulu okanye ovuthayo wendawo oqhekezayo bayaqatyiswa ngokuthe ngqo malunga nokuqhubela phambili ngokutsha kwakhona.
Xa uqwalasela ukusetyenziswa kwemitha kunye nokuvuselelwa kwebele, kubalulekile ukuchonga uhlobo oluthile lotyando olulungile kuwe:
I-Autologous Tissue Breast Reconstruction
Ukwakhiwa kwamathambo e-Autologous yindlela eqhelekileyo yokuhlinzwa, kwaye kukho iindlela ezininzi ezinokusetyenziswa, zonke ezibandakanya ukusetyenziswa kwezicubu ezivela kwinxalenye yomzimba ngaphandle kwebele.
Omnye ubizwa ngokuba yi- TRAM flap , ebizwa nge-transverse rectus abdominis muscle (TRAM) esetyenziswa kwinkqubo. Oku kusebenza ngokusemandleni kubasetyhini abanamafutha amaninzi kwisisu sabo okanye isikhumba esolulelwe ekukhulelweni.
Uhlobo olutsha lwe-autologous reconstruction lubandakanya i-epigastric artery flap (SIEA) engaphantsi kwe-epicastric artery (i-SIEA) kunye ne-deeper infigastric artery perforator flap (DIEP), esebenzisa ulusu lomzimba kunye namafutha.
Njengoko i-post-mastectomy imisebe ichaphazela igazi kwiinkonzo kunye nezicubu zesifuba, i-cosmetically, kungcono ukugqithisa kuqala uze ungenise i-flap kamva kunokuzama ukukhenkceza i-flap kwisisu okanye ngasemva.
Implantshi yokuSebenza okanye yeBreast
Izixhobo zokufakelwa okanye izibeleko zivame ukufakwa emva kokuba i-expander yenyama ikhulise ngokuthe ngcembe ubungakanani bento ebizwa ngokuba "isilonda sesifuba." Izimpembelelo zesisu zixhaphazwa kuphela kubasetyhini abanamafuba amancinci okanye aphakathi kwabo abangenazo izicubu eziswini zokufumana i-TRAM. Ukuba ucingisisa ngemitha emva kokufakelwa, qiniseka ukuba ufumana i-expander kunye nechweptiki yeplastiki endaweni yesinyithi.
Ngoxa i-TRAM ibangela umngcipheko ophezulu we-necrosis ye-fat, kuyona ndlela ikhethekileyo yokuphepha ukuhlinzwa ngokutsha emva kweemitha. Kungaba yinto enqwenelekayo kunabo abalindele ukwakhiwa kuze kube emva kwemisebe ngenxa yokuba izicubu ezithathwe kwisisu, emva okanye kwenye indawo emzimbeni awunakushiswa.
I-Chemotherapy kunye nezinye izinto zokuQiniswa kweBesia
Ingaba izigulane ze-mastectomy kufuneka zilibale ukuhlaziywa kwakhona kuze kube sekupheleni kwe-chemotherapy enye enye ingxoxo. Olunye uphando lwabasetyhini abaye bafumana i-chemo emva kokuphinda lwakhiwo lwabonisa ukunyuka kwe-25% kwinani lokuthotyelwa kokulandelwa kwezizathu zokuzilungisa. Kwaye kukho olunye umba: Ukuba i-chemo ilawulwa ngokukhawuleza emva kokuvuselelwa kwakhona, inokumisa inkqubo yokuphilisa, ukudala umngcipheko omkhulu wokusuleleka.
Izigulane ezicwangcisiweyo zokuba nezimpembelelo zinokunyuka kwandiswe ngexesha le-mastectomy. Emva koko, ukuba kunyanzelekile, banokufumana i-chemotherapy ngexesha leenyanga eziliqela kuthatha ukwandisa ukunqanda ulusu (ngaphambi kokuba iziplani zikhona).
Kukho uhlangothi lwe-flip kumba wokuba unyango luchaphazela iziphumo zokuhlinzwa ngokutsha: Ngaba unyango luchaphazela unyango olulandelayo? I-Chemotherapy iqala ngokukhawuleza emva kokuhlaselwa kwe-mastectomy. Ukuba i-chemo ilibazisekile ukuphepha ukuphazamiseka kwinkqubo yokuphilisa, ukusebenza kwayo kuyancipha. Ukulahla i-radiation, edlalwa kuphela emva kwe-chemotherapy, ingaba ngaphezu kokuphindwe kabini kwinqanaba lokuphindaphinda lomdlavuza wesibeleko.
Ngaphantsi
Okwangoku, kunemibuzo emininzi njengeempendulo xa kuziwa ngexesha lokuvuselelwa kwebele kunye nokunyangwa kwe-post-mastectomy. Ukuba kwaye nini na ukuvuselelwa kwebele kuyisigqibo esitshintsha ubomi kwisigulane esele senza ezinye izinto ezininzi ezibalulekileyo. Ngolwazi oluphikisanayo oluvela kwimithombo emininzi, uphando ngemiba kunye nokuthetha noogqirha bakho kubaluleke kakhulu ngaphambi kokuba ulungise kwisisombululo esifanelekile.
Imithombo:
Anderson, PR, et al. "I-Post-mastectomy Chest Wall Radiation kwi-Expander Tanderue Expander okanye Implantation Endless Breast - Ngaba Kukho Ukholo Kwiinkalo Zengxaki?" I- International Journal ye-Radiation OncologyBiologyPhysics . 692003 S75 - S76. (ubhaliso)
"I-Expander Device Device". mdanderson.org . Ngo-2008. IYunivesithi yaseTexas MD Anderson ICancer Centre.
"Ukubuyiswa kwesisu emva kweMastectomy." Cancer.org . 10/20/2015. American Cancer Society.
Christy Russell. I-Cancer Oncologist. IYunivesithi yaseSouth California yaseLos Angeles. Ifowuni Ingxoxo.
"Ukulahla Ukwelashwa Kwemitha Kukhokelela Ukunyuka Kwemhlaza." nomdlavuza.org . 26 Febhuwari 2003. I-American Cancer Society.
"Impembelelo Yonyango Lwezonyango Zengamayeza Emva Kwi-postmastectomy Breast Reconstruction." oncolink.upenn.edu . 31 Oktobha 2007. I-Abramson Cancer Centre kwiYunivesithi yasePennsylvania.
Keiler, L., et al. "Impembelelo yonyango lwe-Radiation Remediation Post-Postmastectomy Breast Reconstruction." I- International Journal ye-Radiation OncologyBiologyPhysics 692007 S76.
"Iimiphumo zexesha elide lomlilo." mdanderson.org . Ngo-2008. IYunivesithi yaseTexas MD Anderson ICancer Centre.
"Isifundo sichaza iNgxaki eziphantsi kweeRhafu zokuHlawulwa emva koPhulo lweMitha ." I-Hopkinsbreastcenter.org . NgoNovemba 2003. I-Johns Hopkins Breast Centre.
"Isikhokelo esibonelele ngesineke Isibeleko sokuBuyiselwa kwesisu." mdanderson.org . Ngo-2008. IYunivesithi yaseTexas MD Anderson ICancer Centre.
"Yintoni endiyenzayo malunga neengxaki zesikhumba?" nomdlavuza.org . 2 Oktobha 2007. UMbutho weCancer Cancer.