Mastoplastica riduttiva e Mastopessi

 

Mastoplastica riduttiva e Mastopessi

Il rimodellamento e la riduzione del volume mammario sono l’essenza dell’intervento di Mastoplastica Riduttiva.
La motivazione principale che spinge le pazienti a sottoporsi a questo intervento è sicuramente di tipo estetico, anche se una mammella voluminosa crea ulteriori disagi come il peso, il dolore, la difficoltà nelle attività fisiche e sportive, la sudorazione, etc.
La tecnica chirurgica è quanto mai varia ed ha subito una radicale evoluzione negli ultimi anni, tanto che attualmente è possibile effettuare questo intervento riducendo al minimo le cicatrici.
L’operazione è praticata in sala operatoria e preferibilmente in anestesia generale.

Quando la mammella, dopo l’allattamento o dopo una dieta, perde il tono ed il volume che aveva  sempre avuto e risulta svuotata, rilassata e cadente, allora si può ricorrere all’intervento di MASTOPESSI che consiste nel sollevamento della mammella e dell’areola per dare loro una posizione più naturale.Se comunque non si è soddisfatti del proprio volume mammario è possibile inserire contemporaneamente anche una protesi per aumentare il volume.
Le cicatrici che residuano sono limitate e in genere di buona qualità.
L’intervento si può effettuare anche in day-hospital e in poche giorni è possibile riprendere una vita normale.

Nel corso degli anni alcuni fattori quali gravidanze, allattamenti, forza di gravità concorrono alla ptosi (abbassamento) della mammella. In seguito all’ invecchiamento cutaneo e alla conseguente perdita di elasticità il seno perde la sua forma, la sua consistenza e diventa cadente.
La mastopessi è quella procedura chirurgica che ridona forma e posizione ad un seno cadente; almeno temporaneamente. (nessun intervento chirurgico può infatti permanentemente bloccare gli effetti della gravità). Quando il seno è piccolo, o ha perso di volume (per esempio dopo una gravidanza),la mastopessi può essere associata a una mastoplastica additiva.
Le migliori candidate all’intervento di mastopessi sono le pazienti che hanno aspettative realistiche dei risultati e che hanno il seno di piccole dimensioni. In questo caso infatti le cicatrici possono essere di dimensioni minori. Spesso l’intervento viene richiesto dopo una gravidanza, ma se la paziente pensa di avere ancora delle gravidanze è preferibile posporre l’intervento chirurgico. Questo non perché l’operazione interferisca ad esempio con l’allattamento o con altri aspetti della gravidanza, quanto perché in seguito all’aumento di volume e alla seguente atrofia post-gravidica verrebbe vanificato il primo intervento.
Seni di qualsiasi forma e grandezza possono essere sottoposti ad un intervento di mastopessi, ma quelli di maggiori dimensioni devono aspettarsi una più breve durata del risultato nel tempo.
Rischi
L’intervento di mastopessi è un intervento importante, prevede una procedura lunga e come tutti gli interventi presenta complicanze generiche e specifiche associate ad esso. Tra le complicanze generiche ricordiamo: sierosi, ematomi, infezioni. Tra quelle specifiche: la riduzione o perdita di sensibilità del complesso areola-capezzolo.
La mastopessi, a seconda del grado di ptosi mammaria e quindi della tecnica che può essere utilizzata, lascia in ogni caso delle cicatrici permanenti ed evidenti, che vengono comunque nascoste in un reggiseno o in un costume da bagno. Può talvolta verificarsi una non omogeneità di dei due complessi areola-capezzolo. Una scadente cicatrizzazione, sia nella durata che nella qualità è molto comune nelle pazienti fumatrici.

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.

L’intervento chirurgico
L’intervento di mastopessi è simile a quello di riduzione mammaria e richiede da 1 ora e mezza a tre ore a seconda della grandezza del seno. Le tecniche sono varie e le incisioni variano da semplici periareolari a pari-areolare più verticale sino a quelle a “T” invertita a seconda sempre della grandezza del seno. Tubicini di drenaggio possono essere utilizzati in alcuni casi e rimossi pochi giorni dopo l’intervento.
Alcune pazienti, come quelle che hanno un seno di piccole dimensione e quindi con una ptosi molto ridotta, possono essere sottoposte a procedure chirurgiche che prevedono cicatrici ridotte. La più frequentemente utilizzata tra queste tecniche è quella che prevede la rimozione della cute in eccesso ed il riposizionamento in alto del complesso areola-capezzolo mediante la sola cicatrice peri-areolare.
La protesi mammaria viene eventualmente inserita sempre attraverso lo stesso accesso necessario alla correzione della ptosi.
Tutte le metodiche prevedono un bendaggio particolare che viene mantenuto per le prime 48 ore.

L’Anestesia
La mastopessi viene generalmente eseguita in Anestesia Generale. In pazienti selezionati possono essere praticate tecniche con cicatrici ridotte e di conseguenza interventi che vengono condotti in Anestesia Locale con sedazione.

Il post-operatorio
Dopo l’intervento la paziente indosserà un reggiseno conformato per 4 settimane. Le prime due giorno e notte, le seconde 2 soltanto di giorno.
Dopo l’intervento è lecito attendere la comparsa di un edema che tende a scomparire in 4-6 settimane. Il dolore è molto modesto, ben controllabile con i farmaci e lascia rapidamente il posto ad un fastidio. I primi punti di sutura vengono rimossi in 7° giornata, gli ultimi in terza settimana. E’ normale avere una ridotta sensibilità del complesso areola-capezzolo ed anche di un lato rispetto a quello contro laterale. Tale riduzione di sensibilità tende a risolversi spontaneamente nello spazio di alcuni mesi. In alcuni casi può richiedere anche un anno o più e raramente può essere definitiva.

Informazioni più dettagliate legate al proprio caso clinico vanno discusse con il chirurgo in fase di consultazione.

Ripresa dell’attività
Il ritorno alle normali attività è in relazione all’entità dell’intervento subito, alle condizioni fisiche in cui si è affrontato l’intervento chirurgico ed alle singole capacità reattive.
E’ buona norma comunque attendere almeno una settimana prima della ripresa graduale dell’attività e comunque interrompere per almeno quattro quella sportiva.
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
Bisogna ancora una volta ricordare come le cicatrici di questo intervento siano estese e permanenti e che occorrono molti mesi prima che tendano a migliorare e ad essere meno evidenti, potendo talvolta diventare delle sottili linee bianche.
Bisogna ancora ricordare come l’intervento di mastopessi non fermi l’invecchiamento dei tessuti, né possa contrastare le leggi di gravità, ma se le aspettative della paziente sono realistiche, i risultati danno grandi soddisfazione.

La mastopessi 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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