সংজ্ঞা
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 mastectomy (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.
পদ্ধতির কারণ
The goal of the procedure is to create a reconstructed breast that appears as similar to the natural breast as possible.
সম্ভাব্য জটিলতা
Complications are rare, but no procedure is completely free of risk. If you are planning to have a breast reconstruction, your ডাক্তার একটি তালিকা পর্যালোচনা করবে of possible complications which may include:
- রক্তপাত
- সংক্রমণ
- ব্যাথা
- Abnormal scarring
- Painful and/or restricted arm and shoulder motion
- 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
- The need to have more surgeries, including having the implants removed
জটিলতার ঝুঁকি বাড়াতে পারে এমন কিছু কারণের মধ্যে রয়েছে:
- স্থূলতা
- ধূমপান
- রক্তক্ষরণ ব্যাধি
- অপুষ্টি
- Chronic illness or debilitation (e.g., heart disease, lung disease)
- Prior radiation therapy to the chest wall (which may make healing more difficult)
- কেমোথেরাপি
Silicone filled breast implants are not designed to last a lifetime. They typically need to be removed within 10 years. Your risk for complications increases the longer you have the implants.
কি আশা করা যায়
পদ্ধতির আগে
- আপনার ডাক্তার নিম্নলিখিত করতে পারেন:
- শারীরিক পরীক্ষা
- রক্ত পরীক্ষা
- Electrocardiogram (ECG, EKG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle
- ম্যামোগ্রাম
- 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.
- পদ্ধতিতে এবং থেকে একটি যাত্রার ব্যবস্থা করুন।
- পদ্ধতির পরে বাড়িতে সাহায্যের ব্যবস্থা করুন।
- 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.
এনেস্থেশিয়া
General anesthesia is most often used for this procedure.
পদ্ধতির বর্ণনা
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.
অবিলম্বে প্রক্রিয়া পরে
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.
কতক্ষণ এটা লাগবে?
About 2-6 hours
এটা কতটা আঘাত করবে?
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.
গড় হাসপাতালে থাকার
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.
পোস্ট-প্রক্রিয়া যত্ন
- Managing pain and nausea—You might require anti-nausea and pain medicines. You may be nauseated for a few hours after surgery and may not be able to eat normally. Therefore, you may continue to receive fluids and sugar through an IV. For several days after surgery, you may need to eat a lighter, blander diet than usual.
- 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.
আপনার ডাক্তারকে কল করুন
আপনি হাসপাতাল ছেড়ে যাওয়ার পরে, নিম্নলিখিতগুলির মধ্যে যেকোনটি ঘটলে আপনার ডাক্তারের সাথে যোগাযোগ করুন:
- Signs of infection including fever and chills
- লালভাব, ফোলাভাব, ক্রমবর্ধমান ব্যথা, অত্যধিক রক্তপাত, বা ছেদ স্থানে স্রাব
- ব্যথা যা আপনি ওষুধ দিয়ে নিয়ন্ত্রণ করতে পারবেন না
- বমি বমি ভাব এবং/অথবা বমি যা আপনি অস্ত্রোপচারের পরে দেওয়া ওষুধ দিয়ে নিয়ন্ত্রণ করতে পারবেন না, বা যা হাসপাতাল থেকে ছাড়ার পরে দুই দিনের বেশি সময় ধরে থাকে
- Implants grow hard or you believe that they are leaking
- জয়েন্টে ব্যথা, ক্লান্তি, শক্ত হওয়া, ফুসকুড়ি বা অন্যান্য নতুন উপসর্গ
- Pain and/or swelling in your feet, calves, or legs, sudden shortness of breath or chest pain
জরুরী পরিস্থিতিতে, অবিলম্বে চিকিৎসা সহায়তার জন্য কল করুন।