Ukwakhiwa kwesisu kuyinto engaphezu kwengqondo yabesifazane abaningi uma beyazi ukuthi kumele baphathe isisu . Ngaphezulu kokubhekana nokucindezeleka komuthi wokuxilongwa komdlavuza, abesifazane ababhekene nempi yokulwa nesifo se-mastectomy ngolwazi lokuthi imizimba yabo ngeke ibe yinto efanayo. Bangase bakhathazeke ngokuheha kwabo nokuziphatha ngokocansi ngemuva kokuhlinzwa, futhi babuke ekuvuseleleni amabele njengendlela yokubhekana nalabo abakhathazekayo.
Umqondo wokuvuselelwa kwebele ungase ukhange kakhulu ngoba ungase ubonakale njengendlela yokubukeka nokuzizwa "ujwayelekile" futhi. Kungenzeka ukuthi uqale ukuhlinzwa kabusha ngenkathi usaphansi kwe-anesthesia enikezwe i-mastectomy. Kodwa kuthiwani uma udinga ukuthola imishanguzo kanye ne- chemotherapy ngemuva kokuvuselelwa kwesifuba sakho? Ingabe lezo zokwelashwa ziyolimaza imiphumela oyithemba ukuyifinyelela?
Kuze kube yiminyaka embalwa edlule, ochwepheshe abaningi baxwayisa ngokuvuselelwa kwebele ngaphambi kokushiswa kwemisebe. Kodwa izifundo zamuva, kuhlanganise nesikhungo se-Fox Chase Cancer eFiladelphia nesinye se-University Hospital saseCleveland, siphetha ngokuthi asikho isizathu sokuyivala. Noma kunjalo, iziphathimandla zezokwelapha aziphikisana ngokuthi iziguli kufanele zilinde noma ziqhubeke.
Noma yisiphi isiguli esibheka ukuvuselelwa kwesifuba kufanele sibheke isazi sezokuvuselela isifuba (kanye ne-oncologist yakhe) ngokushesha ngemva kokuhlolisiswa komdlavuza ngangokunokwenzeka ukuze kutholakale inkambo yakhe yesenzo.
Icala Lokuhamba Ngaphambi Kokuvuselelwa Kwamabele
Kunezinzuzo eziningi ekuvuselelweni kwesifuba ngokushesha. Iningi lokuvuselelwa kwesifuba kudinga ukuhlinzekwa okungaphezu kweyodwa, futhi ukuliqala ngenkathi lisaphansi kwe-anesthesia ye-mastectomy kusho ukuthi inqubo iqhubeka kahle ngaphambi kokuba isiguli siphakamise.
Umzimba wokugaya isikhumba, oshiya i-"sac" yesifuba, ukwaziswa kuphela uma ukuvuselelwa kuyasondela.
Njengomthetho ojwayelekile, abesifazane abanomdlavuza webele wesandulela-ngculazi (izicubu ezincane ezingakaze zisakaze kuma-lymph nodes noma ukuqhubekela phambili kwazo kuhlanganiswe ezingxenyeni ezifanayo ngaphansi kwesifuba esithintekayo) zingaqhubeka nokuvuselelwa. Ngaphandle kokuba kubonakale ukuthi isiguli sidinga imishanguzo ngemuva kwesifo sayo somzimba ngenxa yomdlavuza omkhulu kakhulu esifubeni noma emdlalweni osobala emcimbini, uDkt. Christy Russell, oncologist webele eYunivesithi yase Southern California, ukhetha ukuthi ukwakha kabusha kuphelile ngesikhathi se-mastectomy.
Kodwa-ke, kungaba nzima ukuthola ukuthi imilayezo iyodingeka yini kwezinye iziguli ngaphambi kokuba izidumbu zazo zifinyelele. NgokukaDkt. Russell, abahlinzayo abaningi ababelethwe ngamathambo bangathanda ukuba isiguli siguquke ngokushesha, kunokuba sikwenze ukubambezeleka ukuze sigweme ukuhlinzeka kwesibili esikhulu kanye nokuhlinzwa okunesihlungu.
Izinkinga ezingenzeka zingaba ezokwelapha, izimonyo noma zombili. Zingabandakanya ukwakheka kwezicubu zomzimba zesifuba esingeziwe, ukuqina kwezicubu, ukutheleleka noma i-necrosis (ukufa) kwamanye amathishu amafutha, okungabangela ukukhanya. Uma kuningi, izinkinga zingadinga ukuhlinzekwa okuqhubekayo ukulungisa noma ukulungisa kabusha.
Ucwaningo olusha luphetha ngokuthi lapho imisebe ilandela ukuvuselelwa kwebele, azikho ukwanda kwezinkinga ezincane noma ezinkulu. Ucwaningo oluthile oluthole ukuthi iziguli ezingama-75% ezazivuselela isifuba ngaphambi kokushiswa kwemisebe zichaze umphumela wezithokozi njengokuhle kakhulu, okufana nokufana nokugculisa iziguli ezingenayo imisebe.
Ukuhlinzekwa kabusha kwesikhatsi ngesikhatsi se-mastectomy kuvame kakhulu emasimini etikwehlukene tetikwelapha letiba ne-oncologists kanye nalabahlinzeksthi betiplastiki basebenta ngekuhlanganyela esikhungweni lesifanako.
Icala Lokulinda Ukuvuselelwa Kwebele
I-American Cancer Society ithi odokotela abaningi batusa ukubambezeleka kokuvuselelwa kwalabo abazi ukuthi bazoba nemisebe, okungaba yingxenye yazo zonke iziguli.
Ngokuhamba kwesikhathi, imisebe ingathinta unomphela isikhumba, ukuthungwa nokuqina kwesikhumba, okungathinta ukubukeka kwamabele.
Abesifazane abazi ukuthi banomdlavuza wesifuba ophakathi noma ophakeme (labo abanezikhumba ezingaphezu kwamamentimitha angu-5 anama-lymph nodes abathintekile) bayelulekwa ukuba balinde izinyanga eziyisithupha ngonyaka ukuze kuhlinzekwe kuze kuphele ukuphulukiswa. Labo abanomdlavuza wesifuba ophuthumayo noma ovuthayo basuke bexwayiswa ngokuqinile ngokuqhubeka nokuvuselelwa ngokushesha.
Uma ucabangela ukuvuselelwa kwemisebe nokuvuselelwa kwebele, kubalulekile ukunquma ukuthi yiluphi uhlobo lokuhlinzeka okungcono kuwe:
I-Autologous Tissue Breast Reconstruction
Ukwakhiwa kwezicubu ezitholakala ku-Autologous kuyindlela ejwayelekile kakhulu yokuhlinzwa, futhi kunezindlela eziningana ezingasetshenziswa, konke okubandakanya ukusetshenziswa kwezicubu ezivela engxenyeni yomzimba ngaphandle kwebele.
Elinye libizwa ngokuthi i- TRAM flap , ebizwa nge-transverse rectus abdominis muscle (TRAM) esetshenziselwa inqubo. Lokhu kusebenza kahle kakhulu kwabesifazane abanamafutha amaningi ngokweqile esiswini noma isikhumba esilulekile kusukela ekukhulelwe.
Izinhlobo ezintsha zokuvuselela izicubu ze-autologous zihlanganisa i-epicastric artery flap engezansi (i-SIEA) ne-deeper artery epigastric flap perforator (DIEP), futhi isebenzisa isikhumba namanoni esiswini.
Njengoba i-post-mastectomy imisebe yithinta ukuhlinzeka kwegazi esikhumbeni nasezicathulweni zesifuba, ngokuzenzekelayo, kungcono ukukhipha kuqala bese ufaka i-flap kamuva kunokuzama ukukhipha i-flap esiswini noma ngemuva.
Izimpande ze-Artificial noma Breast
Izimpande ezifakelwayo noma ezibelethwayo zivame ukufakwa ngemva kokuba isikhukhula se-tissue sithuthukise kancane kancane lokho okubizwa ngokuthi "isilonda sebele." Izimpande zebele zivame ukuphakanyiswa kuphela kwabesifazane abanezinsana ezincane kuya ezilinganisweni noma labo abangenayo izicubu ezanele zesisu se-TRAM okufanele zenziwe. Uma ucubungula imisebe emva kokufakelwa, qiniseka ukuthi uthola i-expander nge-port port esikhundleni sensimbi eyodwa.
Ngenkathi i-TRAM ibeka ingozi ephezulu ye-fat necrosis, kungcono ukugwema ukuhlinzekwa kokulungisa okuzayo ngemuva kwemisebe. Kungase kube yindlela enhle kunazo zonke kulabo abalinde ukwakha kabusha kuze kube ngemva kwemisebe ngoba izicubu ezithathwe esiswini, emuva noma kwenye indawo emzimbeni awunakhanjiswa.
I-Chemotherapy nokunye okucatshangelwa ukuvuselelwa kwebele
Kungakhathaliseki ukuthi iziguli ze-mastectomy kufanele ziphuze ukuvuselela kabusha kuze kube sekupheleni kwe-chemotherapy enye ingxabano. Ucwaningo olwengeziwe lwabesifazane ababhekana ne-chemo ngemuva kokuvuselelwa kwabonisa ukuqhuma kwe-25% kwinani lokuhlinzwa okulandelwayo ngezizathu zezimonyo. Futhi kukhona olunye udaba: Uma i-chemo isetshenziswa ngokushesha ngemuva kokuvuselelwa, ingamisa inqubo yokuphulukisa yemvelo, idale ingozi enkulu yokutheleleka.
Iziguli ezihlela ukuba nezimplantshi zingaba nezandiso ezifakwe ngesikhathi se-mastectomy. Emva kwalokho, uma kunesidingo, bangakwazi ukuthola i-chemotherapy phakathi nezinyanga ezimbalwa kuthatha ukwandisa isikhumba (ngaphambi kokuba izimila zikhona).
Kukhona ohlangothini lwe-flip empikiswaneni yokuthi ngabe ukwelashwa kuthinta imiphumela yokuhlinzwa okuvuselelayo: Ingabe ukuhlinzwa kuthinta ukwelashwa okulandelayo? I-chemotherapy iqala ngokushesha ngemva kwe-mastectomy. Uma i-chemo ibambezeleka ukugwema ukuphazamisa inqubo yokuphulukisa, ukusebenza kwayo kungancipha. Ukuyeka ukushisa imisebe, okuvame ukunikezwa emva kwe-chemotherapy, kungaphezu kokuphindwe kabili izinga lokuphindaphinda lomdlavuza wesifuba.
Okubalulekile
Njengamanje, kunemibuzo eminingi njengezimpendulo uma kuziwa ngesikhathi sokuvuselelwa kwebele kanye nokwelashwa kwe-post-mastectomy. Ukuvuselelwa kwesifuba uma futhi nini ukushintsha izinqumo ezithinta ukuphila kweziguli ezivele zenza ezinye izinqumo eziningi ezibalulekile. Ngolwazi oluphikisanayo oluvela emithonjeni eminingi, ukucwaninga ngalezi zindaba nokukhuluma nodokotela bakho kubaluleke kakhulu ngaphambi kokuxazulula isisombululo esifanele wena.
Imithombo:
U-Anderson, u-PR, no-al. "I-post-mastectomy Chest Wall Radiation kuya ku-Expander Tissue Expander noma ukufakelwa kwebele okuhlala unomphela - Ingabe Kukhona Ukuhluka Kokuncintisana Kwama-Breast?" I- International Journal of Radiation OncologyBiologyPhysics . 692003 S75 - S76. (ukubhalisa)
"I-Expander Device Device". mdanderson.org . 2008. I-University of Texas I-MD Anderson Cancer Centre.
"Ukwakhiwa Kwebele Isisu Ngemva Kwemastectomy." Cancer.org . 10/20/2015. I-American Cancer Society.
Christy Russell. I-Cancer Oncologist ye-Breast. I-University of Southern California Los Angeles. Ifoni Ingxoxo.
"Ukulahla Ukwelashwa Kwemisebe Yomuthi Kuholela Ekugodleni Kwemdlavuza." umdlavuza.org . 26 Feb. 2003. I-American Cancer Society.
"Impact ye-Postoperative Therapy Treatment on Postmastectomy Breast Reconstruction." oncolink.upenn.edu . 31 Okthoba 2007. Isikhungo se-Abramson Cancer eNyuvesi yasePennsylvania.
Keiler, L., et al. "Impact ye-Postoperative Therapy Treatment on Postmastectomy Breast Reconstruction." I- International Journal of Radiation OncologyBiologyPhysics 692007 S76.
"Imiphumela Yesikhathi Eside Yomsindo." mdanderson.org . 2008. I-University of Texas I-MD Anderson Cancer Centre.
"Ukufundwa Kwembulwa Ukuncintisana Okuphansi Kwezindleko Zokwakhiwa Kwamanje Ngemva Kwemithi Yokwelashwa ." I-Hopkinsbreastcenter.org . NgoNovemba 2003. Isikhungo sezinhlungu sikaJohn Hopkins.
"Umhlahlandlela Olwahlelwe Ngumgulane Wokuvuselelwa Kwebele Lwebele." mdanderson.org . 2008. I-University of Texas I-MD Anderson Cancer Centre.
"Ngingenzenjani Ngenkinga Yesikhumba?" umdlavuza.org . 2 Okthoba 2007. I-American Cancer Society.