Breast reconstruction editor

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As the name implies, breast reconstruction is to reconstruct a person's breast, and to help people who have lost their breasts rebuild a new breast through surgery. If the breast is missing and the breast deformity is serious, breast reconstruction can be carried out to create new breasts and improve the shape of the breasts.

catalogue

1 Basic introduction

2 surgical methods

3 the best time

4 method classification

Five preventive measures

Preoperative attention

Postoperative attention

6 surgical effect

7 operating price

Eight signs

9 postoperative nursing care

10 contraindication

1 Basic Introduction Editing

Patients with breast tumors who have received or will receive surgical treatment often leave some or all defects in their breasts, which will cause physical and psychological troubles to patients.

Breast reconstruction

Into a huge trauma. For example: radical mastectomy, modified radical mastectomy, partial mastectomy, skin-preserving mastectomy and preventive mastectomy. In addition, patients with benign breast tumors will also encounter anxiety of partial or even total mastectomy, which can be solved by breast reconstruction. Generally speaking, there is no age limit for breast reconstruction, and breast reconstruction can be done as long as health conditions permit.

Breast reconstruction surgery can be divided into immediate reconstruction and delayed reconstruction, also known as primary reconstruction and secondary reconstruction. Primary reconstruction is breast reconstruction immediately after radical mastectomy, and at the same time as surgical treatment. In this way, there will be no experience of chest loss, and there will be no mental depression caused by physical defects. Delayed reconstruction was performed for a period of time after radical mastectomy. All patients have experienced the pain of breast loss, and they are fully prepared and need reconstruction. After reconstruction, they can not only restore the beauty of women's body curves, but also restore women's sense of spiritual loss.

According to the different materials used in "breast reconstruction", the methods of breast reconstruction are divided into autologous flap reconstruction and prosthesis reconstruction. Skin flap reconstruction is the latest technology of breast reconstruction surgery, which can create the most natural-looking breast. In this method, doctors take tissues from patients' body parts such as back or abdomen to make skin flaps, skin, fat and muscles to make new breasts.

2 surgical method editing

The main methods of breast reconstruction are prosthesis implantation, autologous tissue transplantation and autologous tissue combined prosthesis transplantation.

1, Prosthetic breast reconstruction, which began in the early 1960s and prevailed in the 1980s. The operation method is simple and suitable for patients with good local soft tissue coverage and unwilling to lose autologous tissue in other parts of the body. The method is to place the prosthesis filled with silica gel, silica gel or normal saline under the skin flap or pectoralis major muscle after mastectomy. If the local tissue can't provide enough cavity to accommodate the prosthesis after mastectomy, a skin dilator can be placed first, and water can be injected regularly after mastectomy. After a sufficient cavity is formed, the dilator can be replaced with a breast prosthesis.

2. Breast reconstruction with autologous tissue transplantation has the advantages of naturalness, durability and good aesthetic effect. The most commonly used are various lower abdominal flaps and latissimus dorsi myocutaneous flaps. Others, such as gluteus maximus myocutaneous flap, anterolateral thigh flap, gracilis transverse myocutaneous flap and tensor fascia lata myocutaneous flap, have been used in breast reconstruction to some extent, but the application has been less.

3. The traditional pedicled rectus abdominis myocutaneous flap was first proposed by Hartampf in 1982. It can be pedicled with unilateral rectus abdominis or bilateral rectus abdominis. The transverse rectus abdominis myocutaneous flap has a large amount of tissue, reliable blood supply and plastic effect on abdominal wall, which is especially suitable for middle-aged patients with abdominal distension. The blood supply of the flap depends on the superior epigastric artery and vein in rectus abdominis. The blood of the superior epigastric artery reaches the inferior epigastric artery through spiral artery anastomosis, and then the flap is supplied by the perforating branch of the inferior epigastric artery. Breast reconstruction with single pedicle TRAM flap is prone to blood supply disorder of some flaps. Due to the loss of rectus abdominis, the abdominal wall may be very fragile, which may lead to abdominal hernia. Artificial patch is needed to repair the defect area during operation, which may also cause certain abdominal wall dysfunction. The use of double pedicle TRAM flap makes the blood supply of the flap more reliable. Excision of bilateral rectus abdominis will also increase the chance of abdominal wall complications.

3 the best time to edit

1, if it is a benign breast tumor, only mastectomy can be done and reconstruction surgery can be done at the same time;

2. If it is caused by early breast dysplasia in children, or breast loss caused by trauma, burns and other factors, you can choose surgery in adulthood;

3. If radical mastectomy is performed for breast malignant tumor, it will take 3-5 years to observe and confirm that there are no multiple lesions before reconstruction surgery is feasible.

The time of breast reconstruction is divided into immediate breast reconstruction and delayed breast reconstruction. Patients should choose the best treatment time according to their own situation to achieve the best effect.

Immediate breast reconstruction refers to breast reconstruction and repair at the same time as mastectomy. Delayed breast reconstruction can be performed at any time after mastectomy, usually 9 months after mastectomy, because chemotherapy and radiotherapy can be completed during this period. Some advanced patients need a lot of radiotherapy and chemotherapy, and delayed breast reconstruction can be considered after the condition is stable.

4 method classification editing

(1) breast prosthesis reconstruction

Breast prosthesis reconstruction, namely silica gel, normal saline breast prosthesis and dilator; The reconstructed breast is small in size, covered with good soft tissue locally, and young, and unwilling to sacrifice autologous tissue in other parts of the body. If the local tissue can't provide enough cavity to accommodate the prosthesis with the required size after mastectomy, a skin dilator can be placed first, and water can be injected regularly after mastectomy. When a sufficient cavity is formed, the dilator will be replaced by a breast prosthesis through another operation.

(2) Autologous tissue

Breast reconstruction with autologous tissue is breast reconstruction through tissue transplantation. According to its tissue source, it can be abdomen, buttocks, back, thighs and so on. According to its transfer mode, it can be divided into pedicled transfer and free transplantation.

According to the patient's own specific situation and requirements, experts will give you advice on the most suitable surgical method, so the price of different surgical methods is also different. Your own specific situation is very important for experts to operate, because the patients themselves are very different and the methods of operation are different.

5 note editor

1, patients with organic diseases of important organs or systemic diseases that cannot tolerate surgery.

2. Patients with coagulation disorder.

3. People with severe diabetes

4. Minor patients

5. There are signs of tumor recurrence or metastasis.

6. Those who have unrealistic requirements for the surgical effect.

7, mental patients or emotional instability.

8, all kinds of surgical methods are not suitable for patients.

9, avoid menstruation before surgery.

Preoperative attention

1, before the operation, we should adjust our mentality, solve psychological obstacles and understand the related problems of the operation;

2. Prepare relevant information about breast diseases before operation, and fully communicate with the doctor to let the doctor know the patient's situation and make corresponding countermeasures for the operation;

3. Anticoagulants, ginseng, birth control pills, aspirin, etc. It is forbidden before operation, so as not to prolong the bleeding time during operation;

4, menstrual surgery to prevent hematoma due to breast congestion, prolonged coagulation time, etc. , affecting the surgical effect.

Postoperative attention

1, try to get up for a while on the second day after reconstruction operation;

2. Avoid upper limb movement after operation, and bandage the upper chest when necessary;

3. Inject antibiotics 2-3 days after operation;

4. Remove all drainage strips 65438 0-2 days after operation+replace or remove the dressing at this time;

5. Elastic vest should be worn within 3 months after operation to fix and shape the breast, which can also reduce the tension of incision and prevent the sagging and deformation of reconstructed breast.

6. Avoid excessive exertion, bending over and lifting weights after operation, which will cause swelling or even bleeding in the operation area;

7. Sleep on your back after surgery to avoid oppressing your breasts;

8. The suture was removed 7 ~ 10 days after operation, and the suture could be removed intermittently at the high tension site 10 days after operation;

9, pay attention to diet after surgery, surgical trauma range is larger, should eat high calorie, high protein, high vitamin food, in order to enhance the patient's resistance, is conducive to wound healing.

6 surgical effect editing

After breast reconstruction and plastic surgery, the reconstructed breast feels similar to its own breast tissue, with lasting effect and realistic appearance. However, there is one thing patients should pay attention to. Because the nerves in the chest wall are cut off during breast cancer surgery, the reconstructed breast usually feels numb, or at least less sensitive than the healthy breast. The special feeling of nipple areola caused by sexual stimulation will not exist, but the effect of breast reconstruction is still worthy of recognition.

7 surgical price editing

1. The price of breast reconstruction surgery is related to the operation method. The methods of breast reconstruction are mainly divided into two categories: breast prosthesis reconstruction and autologous tissue reconstruction. Different surgical methods have different prices, even if the same prosthesis is implanted, the price will be slightly different because different patients choose different prosthesis materials. Operation mode is one of the factors that affect the operation price.

Second, the degree of breast loss of beauty seekers will also affect the price of breast reconstruction. Some beauty seekers are missing one nipple and areola while the other nipple and areola are intact, while others are missing both sides. The degree of loss is different. The cost of breast reconstruction will be different with different techniques, time and difficulty of surgery. The more serious the breast tissue defect, the higher the operation price.

Third, the price of breast reconstruction is also affected by plastic surgery hospitals. The comprehensive strength, professional direction and nature of different plastic surgery institutions, the medical services that hospitals can provide and the technical level of doctors are different, and the effect of breast reconstruction is also different, which all affect the cost of surgery to some extent.

8 display editing

1, congenital breast dysplasia;

2. Simple mastectomy is a benign breast tumor;

3. One or both breasts were missing after X-ray irradiation tumor resection due to breast tissue infection and burn in childhood;

4. There are no signs of recurrence for three years after radical mastectomy;

5. Patients who are in urgent need of breast reconstruction after primary and secondary breast cancer surgery;

6. Patients urgently require breast reconstruction. Breast reconstruction can be considered when there are no organic lesions in the main organs of the body.

9 postoperative nursing editor

Breast reconstruction is very difficult, and postoperative nursing is an important prerequisite to ensure the success of the operation. Nursing care after breast reconstruction should pay attention to the following points:

1. After breast reconstruction, negative pressure drainage should be continued for 48 hours, and the surgical wound should be pressurized and bandaged.

2. Take the supine position within 12 hours after breast reconstruction, and change it to semi-supine position after the effect of epidural anesthesia disappears. Restrict activities to reduce bleeding or pain.

3, intravenous drip every 1500-200ml, intravenous antibiotics for 5-7 days.

4. 48 hours after breast reconstruction, open the dressing and pull out the drainage tube; And observe whether the color of skin flap or myocutaneous flap changes. If purple appears, it should be treated immediately and how to care.

5, 3-4 days after breast reconstruction, patients may have fever below 38.5℃, mostly absorbing heat, which can be treated with antipyretic drugs or physical cooling. However, if there is high fever after 5 days, it is necessary to consider whether there is infection, check and deal with it in time, and switch to effective antibiotics.

6. Generally, the suture of breast reconstruction can be removed intermittently within 7 days after operation. How to nurse after breast reconstruction? Remove all stitches within 8- 10 days.