تعريف

Breast reconstruction is plastic surgery to rebuild a breast. It is usually done after amastectomy (removal of the breast) has been done to treat cancer. Reconstruction generally requires several stages. The first stage may be done at the time of استئصال الثدي (immediate reconstruction) or at some point after the mastectomy (delayed reconstruction). Breast reconstruction can be done using an implant or tissue expander followed by placement of an implant. Breast reconstruction can also be done using a tissue flap taken from another part of the body.

إعادة بناء الثدي

أسباب هذا الإجراء

The goal of the procedure is to create a reconstructed breast that appears as similar to the natural breast as possible.

المضاعفات المحتملة

Complications are rare, but no procedure is completely free of risk. If you are planning to have a breast reconstruction, your سيقوم الطبيب بمراجعة القائمة of possible complications which may include:

  • نزيف
  • العدوى
  • الألم
  • تندب غير طبيعي
  • حركة مؤلمة و / أو مقيدة للذراع والكتف
  • Uneven appearance of breasts, due either to position or size
  • Implant may harden, rupture, or leak
  • Implant may make cancer detection (through mammogram and/or self-exam) more difficult
  • Newly reconstructed breast will not have nerve sensation
  • الحاجة إلى المزيد من العمليات الجراحية ، بما في ذلك إزالة الغرسات

بعض العوامل التي قد تزيد من خطر المضاعفات تشمل:

  • السمنة
  • التدخين
  • اضطراب النزيف
  • سوء التغذية
  • Chronic illness or debilitation (e.g., heart disease, lung disease)
  • Prior radiation therapy to the chest wall (which may make healing more difficult)
  • العلاج الكيميائي

غرسات الثدي المليئة بالسيليكون ليست مصممة لتدوم مدى الحياة. عادة ما تحتاج إلى إزالتها في غضون 10 سنوات. يزداد خطر إصابتك بمضاعفات كلما طالت مدة استخدامك للزرعات.

ما يمكن توقعه

قبل الإجراء

  • قد يقوم طبيبك بما يلي:
    • اختبار بدني
    • تحاليل الدم
    • Electrocardiogram (ECG, EKG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle
    • الماموجرام
  • Make sure you talk to your doctor about the medicines you are taking, including over-the-counter drugs and supplements (e.g., ginkgo, vitamin E). Some medicines, like aspirin, may need to be stopped for one week before surgery. You may also need to stop taking blood-thinning medicines like warfarin (Coumadin) or clopidogrel (Plavix) before surgery, since they increase the risk of bleeding.
  • للترتيب من الإجراء.
  • رتبي للحصول على المساعدة في المنزل بعد العملية.
  • The night before, eat a light meal, and do not eat or drink anything after midnight.
  • You may be asked to shower the morning of your procedure. You may be given antibacterial soap to use.

التخدير

General anesthesia is most often used for this procedure.

وصف الإجراء

Implant Procedures

Once you are asleep and no longer feel any pain, a breathing tube will be placed.

A breast implant is the simplest form of reconstruction. It can be done at the time of mastectomy if there is enough skin left on the chest wall. This one-stage, immediate breast reconstruction procedure involves inserting a breast implant where the breast tissue was taken out. The implant can be a silicone shell filled with sterile salt water (saline) or silicone gel. Alloderm or another type of treated skin may also be used to improve the appearance of the reconstructed breast. This type of reconstruction may provide an improved appearance of the breast without resorting to the use of skin and muscle tissue flaps. It is becoming the method of choice in immediate breast reconstruction.

Two-stage reconstruction is done if your skin and chest wall tissues are tight and flat. A tissue expander (temporary implant) is slipped under the skin, and the skin is closed. The expander can then be filled with saline. Over a few weeks, more saline is gradually put into the pouch with a needle. The skin overlying the pouch slowly expands as the pouch grows in size. Some doctors leave this expander in place as the actual implant. Others will replace the tissue expander with a saline or silicone gel implant. This replacement requires additional surgery.

If you want the size, shape, and color of your nipple and areola reconstructed, another surgery may be needed. The nipple can be reconstructed using local tissue. The areola can be reconstructed using skin from the inner thigh. Proper coloring is achieved through tattooing.

Tissue Flap Procedures

More complicated types of breast reconstruction involve using muscle and skin flaps from the abdomen, back, or other parts of your body.

The transverse rectus abdominus muscle (TRAM) flap procedure takes tissue and muscle from the lower abdomen and creates a breast shape. It is then moved to the chest area. Skin, fat, blood vessels, and abdominal muscles are removed, resulting in a tummy tuck. Two types of TRAM flaps exist:

  • A pedicle flap remains attached to the original blood supply under the skin from the abdomen.
  • A free flap is completely cut away from its original location and reattached to blood vessels in the chest area using microsurgery. New advanced techniques may decrease complications and recovery time.

Other procedures include:

  • Gluteal-free flap procedure (less common)—Tissue is taken from the buttocks and reconstructed to form a breast shape. New advanced techniques may decrease complications and recovery time.
  • Latissimus dorsi flap (common)—Skin and muscle is taken from the upper back and tunneled under the skin to the front of your chest.

مباشرة بعد الإجراء

After the operation, you will be taken to the recovery room for observation. You will then be transferred to your hospital room to begin your recovery.

If you have a tissue expander, you will need to have additional saline added gradually. Your doctor will set the schedule.

كم من الوقت سيستغرق ؟

About 2-6 hours

كم هو مؤلم ؟

Anesthesia prevents pain during surgery. You may experience pain after the surgery and during the healing process. Pain medicine will be given to help relieve pain.

متوسط ​​الإقامة في المستشفى

The surgery typically requires up to a week’s stay when done at the same time as a mastectomy. If there are any complications, your hospital stay may be longer.

رعاية ما بعد العملية

  • إدارة الألم والغثيان - قد تحتاج إلى أدوية مضادة للغثيان والألم. قد تشعر بالغثيان لبضع ساعات بعد الجراحة وقد لا تتمكن من تناول الطعام بشكل طبيعي. لذلك ، قد تستمر في تلقي السوائل والسكر من خلال الوريد. لعدة أيام بعد الجراحة ، قد تحتاج إلى اتباع نظام غذائي أخف وزنا من المعتاد.
  • Preventing blood clots—You may be given special compression stockings to wear after surgery. These help to decrease the possibility of blood clots forming in your legs. You will also be encouraged to walk.
  • Improving lung function—You may be asked to use an incentive spirometer . This is a device that helps you breathe deeply. It is important to breathe deeply and cough frequently to improve lung function after general anesthesia.
  • Showering or bathing—Ask your doctor about when it is safe to shower, bathe, or soak in water.

Be sure that you follow-up with your doctor. For silicone gel implants, you will need routine MRI screenings to check for ruptures (tears or holes in the implant). The screenings are typically done three years after surgery and every two years after that.

استدعاء الطبيب

بعد مغادرة المستشفى، اتصل بطبيبك في حالة حدوث أي مما يلي:

  • Signs of infection including fever and chills
  • احمرار، تورم، زيادة الألم، نزيف مفرط، أو إفرازات في موقع الشق
  • ألم لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك
  • الغثيان و / أو القيء الذي لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك بعد الجراحة ، أو التي تستمر لأكثر من يومين بعد الخروج من المستشفى
  • Implants grow hard or you believe that they are leaking
  • آلام المفاصل ، والتعب ، والتصلب ، والطفح الجلدي ، أو غيرها من الأعراض الجديدة
  • Pain and/or swelling in your feet, calves, or legs, sudden shortness of breath or chest pain

في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.