Ukwakhiwa kabusha kwamabele - izicubu zemvelo

Ngemuva kwe-mastectomy, abanye besifazane bakhetha ukuhlinzwa ngezimonyo ukuze baphinde benze isifuba sabo. Lolu hlobo lokuhlinzwa lubizwa ngokuthi ukwakhiwa kabusha kwamabele. Kungenziwa ngasikhathi sinye njenge-mastectomy (ukwakhiwa kabusha ngokushesha) noma kamuva (ukwakhiwa kabusha kokubambezeleka).

Ngesikhathi sokwakhiwa kabusha kwesifuba esisebenzisa izicubu zemvelo, isifuba sakhiwa kabusha kusetshenziswa imisipha, isikhumba, noma amafutha avela kwenye ingxenye yomzimba wakho.

Uma wenza ukwakhiwa kabusha kwesifuba ngasikhathi sinye njenge-mastectomy, udokotela ohlinzayo angenza noma ikuphi kokulandelayo:

• I-mastectomy yokuvikela isikhumba. Lokhu kusho ukuthi kususwa kuphela indawo ezungeze ingono yakho kanye ne-areola.
• Ingono yokuvikela ingono. Lokhu kusho ukuthi sonke isikhumba, ingono, ne-areola zigcinwa.

Kunoma ikuphi, isikhumba sishiywa ukwenza ukwakhiwa kabusha kube lula.

Uma uzoba nokwakhiwa kabusha kwesifuba kamuva, udokotela ohlinzayo usengakwazi ukwenza isikhumba noma ingono yokuvikela imastectomy. Uma ungenaso isiqiniseko sokwakhiwa kabusha, udokotela ohlinzayo uzosusa ingono nesikhumba esanele ukwenza udonga lwesifuba lube bushelelezi futhi lube yisicaba ngangokunokwenzeka.

Izinhlobo zokwakhiwa kabusha kwamabele zifaka okulandelayo:

• I-Transverse rectus abdominus i-myocutaneous flap (TRAM)
• I-Latissimus muscle flap
• I-deep infigastric artery perforator flap (i-DIEP noma i-DIEAP)
• I-flap ekhazimulayo
• I-flap ephezulu ye-gracilis flap (TUG)

Kunoma iyiphi yalezi zinqubo, uzoba ne-anesthesia ejwayelekile. Lo muthi okwenza uhlale ulele futhi ungabi nezinhlungu.

Ukuhlinzwa kwe-TRAM:

• Udokotela ohlinzayo usika (ukusika) esiswini sakho esingezansi, kusuka kwesinye isinqe kuye kwesinye. Isibazi sakho sizofihlwa ngokuhamba kwesikhathi yizingubo eziningi zokugqoka nezokugeza.
• Udokotela ohlinzayo ukhulula isikhumba, amafutha, nemisipha kule ndawo. Lezi zicubu bese zihanjiswa ngaphansi kwesikhumba sesisu sakho ziye endaweni yesifuba ukuze wakhe ibele lakho elisha. Imithambo yegazi ihlala ixhunywe endaweni lapho izicubu zithathwa khona.
• Ngenye indlela ebizwa ngokuthi inqubo ye-flap yamahhala, izicubu zesikhumba, amafutha, nezicubu zisuswa esiswini sakho esingezansi. Lezi zicubu zibekwe endaweni yakho yesifuba ukudala isifuba sakho esisha. Imithambo nemithambo iyanqunywa bese inamathiselwa emithanjeni yegazi engalweni yakho noma ngemuva kwesifuba sakho.
• Lesi sicubu sibe sesifakwa esifubeni esisha. Udokotela ohlinzayo ulingana nosayizi nokuma kwesifuba sakho semvelo esisele eduze ngangokunokwenzeka.
• Ukuqhekeka esiswini sakho kuvaliwe ngemithungo.
• Uma ungathanda ingono entsha ne-areola kudalwe, uzodinga ukuhlinzwa kwesibili, okuncane kakhulu kamuva. Noma, ingono ne-areola kungakhiwa nge-tattoo.

Okwe-latissimus muscle flap ngokufakwa kwesifuba:

• Udokotela ohlinzayo usika umhlane wakho ongaphezulu, ohlangothini lwesifuba sakho esisusiwe.
• Udokotela ohlinzayo ukhulula isikhumba, amafutha, nemisipha kule ndawo. Lesi sicubu bese sidonswa ngaphansi kwesikhumba sakho siye endaweni yesifuba ukuze wakhe ibele lakho elisha. Imithambo yegazi ihlala ixhunywe endaweni lapho kwathathwa khona izicubu.
• Lesi sicubu sibe sesifakwa esifubeni esisha. Udokotela ohlinzayo ulingana nosayizi nokuma kwesifuba sakho semvelo esisele ngokuseduze ngangokunokwenzeka.
• Ukufakwa kungafakwa ngaphansi kwemisipha yodonga lwesifuba ukusiza ukufanisa nosayizi wesinye isifuba sakho.
• Ukuqhekeka kuvaliwe ngemithungo.
• Uma ungathanda ingono entsha ne-areola kudalwe, uzodinga ukuhlinzwa kwesibili, okuncane kakhulu kamuva. Noma, ingono ne-areola kungakhiwa nge-tattoo.

Okwe-DIEP noma kwe-DIEAP flap:

• Udokotela ohlinzayo usika esiswini sakho esingezansi. Isikhumba namafutha akule ndawo kukhululiwe. Lezi zicubu zifakwa endaweni yakho yesifuba ukuze wakhe ibele lakho elisha. Imithambo nemithambo kuyasikwa bese kunamathiselwa emithanjeni yegazi engalweni yakho noma ngemuva kwesifuba sakho.
• Izicubu bese zibunjwa zibe yisifuba esisha. Udokotela ohlinzayo ulingana nosayizi nokuma kwesifuba sakho semvelo esisele eduze ngangokunokwenzeka.
• Ukuqhekeka kuvaliwe ngemithungo.
• Uma ungathanda ingono entsha ne-areola kudalwe, uzodinga ukuhlinzwa kwesibili, okuncane kakhulu kamuva. Noma, ingono ne-areola kungakhiwa nge-tattoo.

Ngokuchofoza okukhazimulayo:

• Udokotela ohlinzayo usika izinqe zakho. Isikhumba, amafutha, futhi mhlawumbe nemisipha evela kule ndawo kuyadedelwa. Lezi zicubu zibekwe endaweni yakho yesifuba ukudala isifuba sakho esisha. Imithambo nemithambo kuyasikwa bese kunamathiselwa emithanjeni yegazi engalweni yakho noma ngemuva kwesifuba sakho.
• Izicubu bese zibunjwa zibe yisifuba esisha. Udokotela ohlinzayo ulingana nosayizi nokuma kwesifuba sakho semvelo esisele eduze ngangokunokwenzeka.
• Ukuqhekeka kuvaliwe ngemithungo.
• Uma ungathanda ingono entsha ne-areola kudalwe, uzodinga ukuhlinzwa kwesibili, okuncane kakhulu kamuva. Noma, ingono ne-areola kungakhiwa nge-tattoo.

Okwe-TUG flap:

• Udokotela ohlinzayo usika ithanga lakho. Isikhumba, amafutha, nemisipha kule ndawo kuyaxegiswa. Lezi zicubu zibekwe endaweni yakho yesifuba ukudala isifuba sakho esisha. Imithambo nemithambo kuyasikwa bese kunamathiselwa emithanjeni yegazi engalweni yakho noma ngemuva kwesifuba sakho.
• Izicubu bese zibunjwa zibe yisifuba esisha. Udokotela ohlinzayo ulingana nosayizi nokuma kwesifuba sakho semvelo esisele eduze ngangokunokwenzeka.
• Ukuqhekeka kuvaliwe ngemithungo.
• Uma ungathanda ingono entsha ne-areola kudalwe, uzodinga ukuhlinzwa kwesibili, okuncane kakhulu kamuva. Noma, ingono ne-areola kungakhiwa nge-tattoo.

Lapho ukwakhiwa kabusha kwamabele kwenziwa ngasikhathi sinye njenge-mastectomy, konke ukuhlinzwa kungahlala amahora ayisishiyagalombili kuya kwayishumi. Lapho kwenziwa njengokuhlinzwa kwesibili, kungathatha amahora afinyelela kwangu-12.

Wena nodokotela ohlinzayo nizonquma ndawonye ngokuthi kufanele nibe nokwakha kabusha amabele nokuthi nini. Isinqumo sincike ezicini eziningi ezahlukahlukene.

Ukuba nokwakhiwa kabusha kwesifuba akukwenzi kube nzima ukuthola isimila uma umdlavuza wakho webele ubuya.

Inzuzo yokwakhiwa kabusha kwesifuba ngezicubu zemvelo ukuthi isifuba esenziwe kabusha sithambile futhi sinemvelo kakhulu kunezimila zamabele. Usayizi, ukugcwala, nokwakheka kwesifuba esisha kungafaniswa eduze nesinye isifuba sakho.

Kepha izinqubo ze-muscle flap ziyinkimbinkimbi kunokubeka okufakwa ebeleni. Ungadinga ukumpontshelwa igazi ngesikhathi senqubo. Imvamisa uzochitha izinsuku ezimbili noma ezintathu esibhedlela ngemuva kwalokhu kuhlinzwa uma kuqhathaniswa nezinye izinqubo zokwakha kabusha. Futhi, isikhathi sakho sokutakula ekhaya sizoba side kakhulu.

Abesifazane abaningi bakhetha ukungabi nokwakhiwa kabusha kwamabele noma okufakelwe. Bangasebenzisa okufakelwayo (ibele lokufakelwa) kubhodisi wabo okunika isimo semvelo. Noma bangakhetha ukungasebenzisi lutho nhlobo.

Izingozi ze-anesthesia nokuhlinzwa yilezi:

• Ukusabela emithini
• Izinkinga zokuphefumula
• Ukopha, amahlule egazi, noma ukutheleleka

Izingozi zokwakhiwa kabusha kwesifuba ngezicubu zemvelo yilezi:

• Ukulahlekelwa umuzwa ezungeze ingono kanye areola
• Isibazi esibonakalayo
• Isifuba esisodwa sikhulu kunesinye (i-asymmetry yamabele)
• Ukulahleka kweqhwa ngenxa yezinkinga zokuhlinzekwa kwegazi, okudinga ukuhlinzwa okwengeziwe ukusindisa i-flap noma ukuyisusa
• Ukopha endaweni lapho bekukhona khona isifuba, kwesinye isikhathi kudinga ukuhlinzwa kwesibili ukulawula ukopha

Tshela udokotela wakho ohlinzayo uma ngabe uthatha noma imuphi umuthi, izithasiselo, noma amakhambi owathengile ngaphandle kwemithi kadokotela.

Phakathi nesonto ngaphambi kokuhlinzwa kwakho:

• Ungacelwa ukuthi uyeke ukuthatha imithi yokwehlisa igazi. Lokhu kufaka phakathi i-aspirin, ibuprofen (Advil, Motrin), uvithamini E, i-clopidogrel (i-Plavix), i-warfarin (i-Coumadin, i-Jantoven), nezinye.
• Buza udokotela wakho ohlinzayo ukuthi yiziphi izidakamizwa okufanele usaziphuza ngosuku lokuhlinzwa kwakho.
• Uma ubhema, zama ukuyeka. Ukubhema kunganciphisa ukuphulukiswa futhi kwandise ingozi yezinkinga. Buza umhlinzeki wakho wokunakekelwa kwezempilo usizo lokuyeka.

Ngosuku lokuhlinzwa kwakho:

• Landela imiyalelo mayelana nokungadli noma ukuphuza nangokugeza ngaphambi kokuya esibhedlela.
• Thatha izidakamizwa zakho udokotela wakho akutshele ukuthi uziphuze kancane.
• Fika esibhedlela ngesikhathi.

Uzohlala esibhedlela izinsuku ezimbili kuya kwezi-5.

Kungenzeka ukuthi usenamapayipi esifubeni lapho uya ekhaya. Udokotela wakho ohlinzayo uzowasusa kamuva ngesikhathi sokuvakasha kwehhovisi. Ungaba nobuhlungu ngokusikeka kwakho ngemuva kokuhlinzwa. Landela imiyalelo mayelana nokuthatha umuthi wezinhlungu.

Uketshezi lungaqoqa ngaphansi kwesimbobo. Lokhu kubizwa nge-seroma. Kuvamile. I-seroma ingahamba yodwa. Uma ingapheli, kungadinga ukukhishwa udokotela ohlinzayo ngesikhathi sokuvakasha kwehhovisi.

Imiphumela yalokhu kuhlinzwa ivame ukuba mihle kakhulu. Kepha ukwakhiwa kabusha ngeke kubuyise ukuzwa okujwayelekile kwesifuba sakho esisha noma ingono.

Ukuhlinzwa kabusha kwebele ngemuva komdlavuza webele kungathuthukisa imizwa yakho yenhlalakahle nekhwalithi yempilo.

I-transverse rectus abdominus muscle flap; TRAM; I-Latissimus muscle flap ngokufakwa kwesifuba; I-DIEP ichopho; I-DIEAP ichopho; I-flap yamahhala ekhazimulayo; I-flap ephezulu ye-gracilis ephezulu; I-TUG; I-Mastectomy - ukwakhiwa kabusha kwesifuba ngezicubu zemvelo; Umdlavuza webele - ukwakhiwa kabusha kwesifuba ngezicubu zemvelo

• Ukuhlinzwa isifuba sezimonyo - ukukhishwa
• I-Mastectomy nokwakhiwa kabusha kwesifuba - okufanele ubuze udokotela wakho
• I-Mastectomy - ukukhipha

IBurke MS, iSchimpf DK. Ukwakhiwa kabusha kwesifuba ngemuva kokwelashwa komdlavuza webele: izinhloso, izinketho kanye nokucabanga. Ku: UCameron JL, uCameron AM, ama-eds. Ukwelashwa Kwamanje. Umhla ka-12. IPhiladelphia, PA: Elsevier; 2017: 743-748.

Amandla KL, Phillips LG. Ukwakhiwa kabusha kwamabele. Ku: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ISabiston Incwadi Yokuhlinzwa: Isisekelo Sebhayoloji Sokuzijwayeza Kwamanje Kokuhlinzwa. Umhla ka-20. IPhiladelphia, PA: Elsevier; 2017: isahluko 35.