Meme Başı Rekonstrüksiyonu
Özet
Meme başı ve areola rekonstrüksiyonu, meme kanseri cerrahisi sonrasında memeyi doğal görünümüne kavuşturmayı ve hastaların psikososyal sağlığı ile beden imajını iyileştirmeyi amaçlayan çok aşamalı rekonstrüktif sürecin son adımıdır. Cerrahi karar, meme höyüğünün nihai şeklini alması ve şişliklerin inmesi için genellikle son ameliyattan 3 ila 5 ay sonra verilir. İdeal bir rekonstrüksiyon; pozisyon, boyut, şekil ve pigmentasyon açısından diğer meme ile simetri sağlamayı hedefler. Bu süreçte yerel flepler, karşı memeden doku paylaşımı, pigmentasyon için intradermal dövme (3D teknikler dahil), deri greftleri ve silikon bazlı iç veya dış protezler gibi çeşitli cerrahi teknikler kombinasyon halinde kullanılabilir. Tekniklerin zaman içinde gelişmesine, minimal morbidite ile tatmin edici sonuçlar sunmasına ve gelecekte 3D baskılı doku iskelelerinin umut vadetmesine rağmen, yöntemlerin süt üretimi veya tam duyusal fonksiyonları geri kazandırmadığı bilinmelidir. Lokal fleplerdeki %45 ila %75 oranındaki projeksiyon kaybı, asimetri, enfeksiyon ve doku nekrozu en yaygın komplikasyonlardır. Bu nedenle ameliyat öncesinde hastanın estetik tercihleri ve riskler detaylıca tartışılmalıdır.
Nipple and areola reconstruction is the final step of the multi-stage reconstructive process following breast cancer surgery, aiming to restore the natural appearance of the breast and improve patients' psychosocial health and body image. The surgical decision is typically deferred for 3 to 5 months after the final surgery to allow the breast mound to settle into its definitive shape and for swelling to subside. An ideal reconstruction aims to achieve symmetry with the contralateral breast in terms of position, size, shape, and pigmentation. Various surgical techniques, such as local flaps, nipple sharing from the opposite breast, intradermal tattooing for pigmentation (including 3D techniques), skin grafts, and silicone-based internal or external prostheses, can be utilized in combination during this process. Although techniques have evolved over time to offer satisfactory results with minimal morbidity, and 3D-printed tissue scaffolds show promise for the future, it is important to note that these methods do not restore milk production or full sensation. A loss of projection ranging from 45% to 75% in local flaps, asymmetry, infection, and tissue necrosis are the most common complications. Therefore, patient preferences and risks must be thoroughly discussed preoperatively.
Referanslar
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