Mastoplastica Additiva

 

Mastoplastica Additiva

Mastoplastica Additiva

Sin dai tempi dell’arte classica greca la mammella è stata il simbolo per eccellenza di femminilità.
E’ comprensibile,quindi, che le sue anomalie, nella forma e nel volume, si accompagnino ad implicazioni psicologiche anche di notevole entità.
“Donne piatte” possono essere così vulnerabili che può diventare molto difficile per loro assumere un ruolo normale nella vita di relazione,lavorativa,sentimentale.etc.
La mastoplastica additiva è l’intervento che produce un aumento del volume delle mammelle, mediante l’inserimento di protesi.Le incisioni cutanee più comuni per mettere il loro inserimento sono quella periareolare, sottomammaria ed ascellare.
L’intervento si esegue in anestesia generale o in sedazione ed anestesia locale, a seconda del caso, e al termine dell’intervento si applica una semplice medicazione con un reggiseno elastico che dovrà essere indossato per circa venti giorni.
Dopo alcuni decenni che vengono utilizzate, si può fare affidamento sulla biocompatibilità e resistenza delle protesi ed escludere qualsiasi correlazione tra presenza di queste e l’insorgenza del cancro della mammella.

L’aumento di volume del seno, che tecnicamente si definisce mastoplastica additiva, è un intervento che si attua con il posizionamento di protesi e che viene eseguito per varie ragioni.

– Per aumentare il volume quando una donna lo ritiene inadeguato;
– Per restituire il volume perduto dopo una gravidanza;
– Per correggere una asimmetria tra i due lati;
– Per ricostruire un seno dopo un intervento demolitivo.

Le migliori candidate per un intervento di mastoplastica additiva sono quelle pazienti che desiderano migliorare il loro aspetto fisico, con prospettive realistiche e che non affidino al risultato aspettative troppo alte.

Le protesi
Le protesi sono dei gusci di silicone ripieni di silicone in forma gelatinosa o di una soluzione di acqua e sali minerali definita Soluzione Fisiologica.
E’ opportuno aprire qui una piccola parentesi per spiegare tutte le voci corse intorno alle protesi ed alla possibile insorgenza di malattie autoimmunitarie o peggio ancora tumorali legate al loro utilizzo.
Nel 1992 negli Stati Uniti, in seguito alla querela di una paziente che denunciò di avere sviluppato un tumore al seno che riteneva essere stato causato dall’inserimento di impianti protesici, la FDA (Federal Drug Administration organo di controllo americano) decise di sospendere l’impiego delle protesi in attesa di studi concreti sulla materia. Venne istituita una commissione di studio e nel frattempo i vari paesi del resto del mondo scelsero di seguire o meno le indicazioni americane.
In realtà esistevano già diversi studi in proposito e tutti escludevano correlazioni tra l’uso di protesi in silicone e la crescita di tumori o lo sviluppo di malattie autoimmuni, infatti la Germania ed il Regno Unito decisero di non prendere neanche in considerazione le decisioni americane. In Italia invece il Ministro della Sanità applicò pedissequamente le disposizioni americane ed i mass-media enfatizzarono e distorsero le notizie incriminando le protesi e scatenando il panico tra le donne già operate e portatrici di impianti. Nel 1995 le protesi furono totalmente scagionate, ma la notizia non venne data con lo stesso risalto ed allora cercheremo qui di dare alcune risposte a quelle che in sede di consultazione ho rilevato essere le domande più frequenti.

Cosa è il silicone
Il silicone è una famiglia di composti chimici con molti usi comuni. Tutti noi ogni giorno usiamo forse senza saperlo, oggetti contenti silicone. Le speciali caratteristiche dei siliconi li rendono ideali per molti prodotti, dagli impianti per uso chirurgico alle creme per le mani o al rossetto. Anche alcuni cibi contengono siliconi. I siliconi vengono prodotti partendo dal silicio, un elemento che si trova in natura nelle sabbie, nel quarzo, nelle rocce. Accanto all’ossigeno, il silicio è l’elemento più comune sulla crosta terrestre e, come per l’ossigeno, sia la vita animale che vegetale dipendono dal silicio. Il silicio diventa silicone quando è combinato con ossigeno, carbonio ed idrogeno. A seconda di come vengono disposte le molecole nel silicone, il silicone stesso può essere prodotto in varie forme: polveri, olii, gel ed elastomeri.

Cosa significa che utilizziamo il silicone senza saperlo
I siliconi per le loro particolari proprietà sono ampiamente usati in prodotti di largo consumo da circa cinquanta anni. Ad esempio poiché in una specifica formulazione il silicone può evitare la formazione di schiuma, lo si può trovare come ingrediente in budini e torte confezionate.
Molte persone lo consumano regolarmente, nella formulazione di simeticone, in alcuni tipi di bibite e farmaci antiacidi. Il simeticone è anche impiegato in alcuni farmaci di uso pediatrico, contro le coliche addominali. Un’altra forma di silicone, il dimeticone, è comunemente contenuta in vari prodotti per la cura e l’igiene del corpo. Nei rossetti, nei lucida labbra e nelle creme per le mani il silicone agisce come una protezione idratante. Anche le creme abbronzanti, le lozioni contro gli insetti, le creme da barba, i dopobarba, i deodoranti, gli shampoo, i balsami e gli spray per i capelli contengono alcune forme di silicone.
Le lenzuola, gli abiti, i fazzoletti diventano soffici al tatto dopo trattamento con silicone. Il silicone è anche usato come idrorepellente per gli ombrelli, impermeabili e cere protettive.
Questi sono solo alcuni degli esempi di impiego del silicone nei prodotti di consumo; sono troppi per poter essere elencati tutti.

Quale è l’impiego del silicone in medicina
Il silicone viene utilizzato in medicina da circa cinquanta anni. Nessun altro materiale ha dimostrato di essere così bio-compatibile, affidabile, flessibile, morbido e facilmente sterilizzabile come il silicone. I siliconi resistono alle sollecitazioni chimiche più spinte come nell’ambiente acido dello stomaco. Per questi motivi il silicone è il materiale scelto più frequentemente per costruire dispositivi medicali da impiantare all’interno del corpo umano.
Il silicone è utilizzato per rivestire aghi e fili chirurgici, l’interno delle siringhe e dei flaconi per la conservazione del sangue o di farmaci per infusione endovenosa, per rivestire pace-makers e valvole cardiache artificiali.
Gli elastomeri di silicone sono il bio-materiale preferito per un’ampia gamma di prodotti biomedicali. Il “ciuccio” per i bebè è spesso fatto di silicone. Il Norplant, nuovo anticoncezionale, si serve di tubicini di silicone impiantabili nel tessuto sottocutaneo per il rilascio graduale di farmaco anticoncezionale nell’organismo. Lenti di silicone permettono di restituire la vista a pazienti resi quasi ciechi dalla cataratta. Drenaggi di scarico in silicone permettono di curare pazienti affetti da glaucoma o da idrocefalo. Sono tubi in silicone quelli che permettono di collegare pazienti nefropatici al rene artificiale per la dialisi. In alcuni pazienti con problemi ortopedici vengono utilizzate articolazioni artificiali in silicone. In Chirurgia Plastica protesi mammarie ed espansori tissutali permettono la ricostruzione od il miglioramento di alcune parti del corpo.

Che relazione c’è tra il silicone ed il tumore della mammella
I materiali di silicone sono stati studiati ampiamente in ricerche di laboratorio. Questi dati sperimentali confermano che i materiali di silicone non provocano il cancro nell’uomo. Questi studi sono molto importanti e forniscono prove fondamentali sulla sicurezza dei prodotti. Ancora più affidabili sono tuttavia gli studi clinici che controllano direttamente l’effetto del silicone sull’uomo. Tra questi i più importanti sono gli studi che riguardano donne alle quali sono state impiantate protesi mammarie da diversi anni.
I tumori della mammella originano dalle cellule dei dotti e dell’epitelio ghiandolare e da qui possono diffondersi in tutto il corpo. In Italia circa una donna su dieci (negli USA una su nove) può sviluppare, nella sua vita, un tumore al seno. Se il silicone aumentasse la probabilità di ammalarsi di cancro, dovremmo aspettarci che le donne portatrici di protesi mammarie fossero più soggette a sviluppare tumori della mammella. Ma non è così. Il risultato di studi clinici conferma che il tumore della mammella non è più frequente in donne con protesi mammarie di quanto non lo sia nelle altre. Uno studio condotto a Los Angeles alla University of Southern California nel 1986 ha esaminato oltre 3.000 donne, alle quali erano state impiantate protesi mammarie in silicone a scopo estetico tra il 1959 ed il 1980; i risultati hanno messo in evidenza che non vi è rischio aumentato di sviluppare tumore al seno in seguito all’inserimento di protesi. Un altro studio condotto all’ University of Calgary in Canada nel 1992 ha preso in esame oltre 11.000 donne cui furono impiantate protesi tra il 1973 ed 1986, ed anche qui fu messo in evidenza che non vi era alcun aumento di rischio a sviluppare tumore al seno in seguito all’inserimento di protesi.

Protesi e mammografia
Poiché le protesi interferiscono, anche se minimamente, negli esami standard bisogna richiedere un esame a proiezioni multiple al radiologo. Il vostro radiologo dovrebbe essere a conoscenza delle attuali tecniche di dislocazione (come ad esempio al tecnica di Eklund) per ottenere proiezioni del tessuto circostante le protesi.

Rischi
L’intervento di mastoplastica additiva è ampiamente standardizzato, ma come tutti gli interventi presenta complicanze generiche e specifiche associate ad esso.
La più comune complicanza specifica è la contrattura capsulare. Bisogna dire che con l’avvento degli ultimi dispositivi protesici, tale evenienza si verifica molto raramente. Esistono vari gradi di contrattura e nei casi più gravi si pone l’indicazione ad un nuovo intervento chirurgico che può essere di indebolimento della capsula, o di rimozione della capsula stessa ed in alcuni casi può essere necessario effettuare il cambio dell’impianto protesico.
Un’altra evenienza che può verificarsi, anche se in una bassissima percentuale di pazienti, è lo sviluppo di una infezione intorno alla protesi. Normalmente accade nel primo post-operatorio (dopo 7-10 giorni). Nei casi più importanti può essere necessario rimuovere la protesi ed attendere alcuni mesi prima di riposizionare una nuovo impianto.
La sensibilità del complesso areola-capezzolo può aumentare, diminuire o essere quasi assente. Tale sintomatologia tende a risolversi spontaneamente nello spazio di alcuni mesi. In alcuni casi può richiedere anche un anno o più e raramente può essere definitiva.
Talvolta, anche se accade difficilmente, le protesi possono rompersi. La rottura è generalmente sempre dovuta ad un trauma importante. Se le protesi sono in soluzione salina, nello spazio di poche ore la mammella interessata risulterà molto più piccola dell’altra. In caso di protesi in gel di silicone è molto più difficile accorgersi della rottura perché generalmente la capsula peri-protesica non consente lo spandimento del gel in tempi brevi (settimane o addirittura mesi). Il verificarsi di fenomeni inusuali deve portare la paziente a recarsi dallo specialista per effettuare accertamenti diagnostici.
Nel caso di rottura dell’impianto, anche se non esiste il carattere di urgenza, è necessario sottoporsi ad un intervento di revisione per rimuovere il gel, ripulire la tasca da residui di silicone e sostituire la protesi mammaria.

Preparazione all’intervento
E’ buona norma, a cominciare dalla settimana precedente all’intervento, non assumere Ac. Acetilsalicico (aspirina) per evitare problemi di coagulazione, e per i fumatori astenersi per almeno 4 settimane (due prima e due dopo l’operazione).
Se si è reduci da un’infezione o una malattia sarebbe prudente posporre l’intervento chirurgico.
Se si viene operati in regime di Day-Surgery (dimissione nello stesso giorno) è indispensabile che il/la paziente venga accompagnato da una persona che possa prendersene cura nel riaccompagnarla a casa e nelle necessità delle prime 24-48 ore. Una paziente reduce da una gravidanza, dovrà attendere almeno 9 mesi dalla fine dell’allattamento.

L’intervento chirurgico
Il metodo di inserimento delle protesi ed il tipo di approccio dipendono dall’anatomia della paziente. L’incisione può essere posizionata nel solco sotto-mammario, intorno all’areola o nel cavo ascellare. Lavorando attraverso questa incisione si crea una tasca sopra o sotto muscolare e si posiziona l’impianto.
Se la paziente ha uno scarsissimo tessuto ghiandolare che non garantisce una buona copertura della protesi è preferibile scegliere il posizionamento sotto-muscolare. Quest’ultimo è leggermente più doloroso di quello sotto-ghiandolare, ma soprattutto si rende evidente, quando viene messo in tensione il muscolo grande pettorale, un lieve spostamento dell’impianto protesico verso l’esterno del torace.
Tubicini di drenaggio possono essere utilizzati in alcuni casi e rimossi pochi giorni dopo l’intervento.
L’intervento dura circa 1 ora e le incisioni vengono chiuse senza punti di sutura esterni al fine di migliorarne l’aspetto finale. Un bendaggio particolare viene mantenuto per le prime 48 ore.

L’Anestesia
L’intervento può essere condotto sia in Anestesia Generale che in Anestesia Locale ed eventuale sedazione secondo i desideri della paziente.

Il post-operatorio
Dopo la prima medicazione la paziente indosserà un reggiseno conformato per 4 settimane. Le prime due giorno e notte, le seconde 2 soltanto di giorno.
Il dolore post-operatorio(mai eccessivo) viene ben controllato da farmaci anti dolorifici e generalmente tende a scomparire dopo 24-48 ore.
Nell’immediato post-operatorio il seno sembrerà ancora più grande di quanto non sia in realtà per l’importante edema (gonfiore) presente, che tenderà gradualmente a ridursi nel corso delle settimane. Almeno 6 ne occorreranno attendere prima di vedere il nuovo seno in condizioni normali ed almeno tre mesi bisognerà aspettare prima di sentirlo sufficientemente morbido.

Ripresa dell’attività
Il ritorno alle normali attività è abbastanza rapido. E’ buona norma comunque attendere almeno una settimana prima della ripresa graduale dell’attività e comunque interrompere per almeno quattro quella sportiva.
Il seno sarà indolenzito ed è quindi consigliabile evitare contatti diretti per qualche settimana.
Nel caso in cui la paziente rimanesse incinta non esistono problemi per un eventuale allattamento in quanto nessuna tecnica prevede l’interruzione dei dotti e la ghiandola rimane funzionalmente intatta.

Il nuovo aspetto
Se le aspettative della paziente sono realistiche la soddisfazione per l’intervento è molto alta.
La mastoplastica additiva può cambiare l’aspetto e restituire quella self-confidence perduta, ma non necessariamente cambia il proprio look secondo i propri desideri o modifica il modo di fare delle persone che ci circondano.

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