The breast is an integral part of a woman’s beauty, yet some women suffer from breast cancer and have their breasts extensively or even completely removed. With the increasing awareness of breast cancer, the early detection rate of breast cancer patients has improved significantly, and with the application of treatment and adjuvant therapy, the survival period of breast cancer patients has been significantly extended. It will not only cause physical defects, but also make patients feel inferior and cause heavy psychological burden to young women and affect their quality of life.
I. Common psychological problems of breast reconstruction after radical breast cancer surgery
1.Suspiciousness
Patients learn that they have breast cancer or some of them know that they may have breast cancer, but they are unwilling to accept the truth and adopt an avoiding attitude. They may even misinterpret the original meaning of others’ advice. This kind of suspicion is a kind of negative self-reference, and the patient becomes unusually sensitive, fidgety, seeking multiple confirmations, nervous and suspicious. At this time, medical and nursing staff should understand the patient’s current psychological state in detail and listen to the main complaint carefully to understand and grasp the patient’s psychological needs and the reasons for his or her worries, and nursing staff should explain the knowledge related to breast cancer treatment and rehabilitation patiently and meticulously from a professional perspective. According to the psychological state that patients are dependent and passive and feel the need for others to take care of them, nursing staff should take the initiative to approach and help solve the difficulties in patients’ life or the problems that bother them, so as to solve their worries.
2.Fear psychology
Female breast tumor patients, before and after surgery, often have fear of treatment due to the lack of breasts, worry about losing their feminine features, reducing their attractiveness and causing the rupture of the couple’s relationship, and feel great mental and psychological pressure. In the face of such patients, we should first give spiritual support and encouragement, approach the patient in many ways, gain the patient’s trust and establish a good nurse-patient relationship. In terms of speech, nurses should be kind and patient, with a gentle tone of voice. Patiently and meticulously explain all kinds of questions raised by patients, and be rigorous in diagnosis, treatment and prognosis of patients with scientific basis, never subjective and arbitrary, and never add to the psychological burden of patients with negative language. Ask patients who recovered smoothly after breast reconstruction to tell their personal experience and recovery experience, and explain the key points of post-breast reconstruction nursing work.
3.Anxiety
Anxiety is a natural response to fear. To address this situation, nursing staff should take the initiative to talk with patients and listen to their confessions. They should provide the patient with comprehensive and correct medical information on the premise of mastering the condition and the progress of breast cancer treatment and cure rate at home and abroad, so that the patient can have a clear mind and stabilize the emotion. We also introduce the knowledge and methods of breast reconstruction surgery, chemotherapy, radiotherapy, endocrine therapy, possible adverse reactions and preventive measures, watch the photos of before and after breast reconstruction with the patient and compare them with each other, explain the knowledge of breast aesthetics and diet, make the patient understand the necessity of the medical program and guide the patient to cooperate with the treatment actively.
4. Depression psychology
Breast cancer not only removes the lesion, but also removes the second female sex characteristics. Moreover, the asymmetry of both sides of the breast after mastectomy destroys the beauty of women’s body. And the negative emotion of sorrow and depression appears, which can be expressed in various ways. Patients in a depressed state have a heavy burden of thought, so we should take the initiative to talk with patients, understand their thought dynamics, pay attention to their emotional changes and abnormal words and actions, and appreciate the patient’s mood. According to the characteristics of the disease and the patient, encourage him/her to participate in some cultural and sports activities to reduce the negative psychology of the patient and alleviate the internal pain. At the same time, we must seek the support and understanding of her husband, whose thoughtfulness and care will be a great help for her to get out of depression.
5.Despair psychology
After breast reconstruction, some breast cancer patients have deterioration, tumor metastasis and adverse reaction to chemotherapy, and so on, they often develop the psychology of despair. At this time, patients’ desire to live is reduced while their desire to die is increased, and they lose confidence in treatment and life. The purpose of nursing is to arouse the patient’s hope and belief in life. In the nursing process, we should use firm expressions and unquestionable language to gain the patient’s trust, help the patient to exclude the bad psychological state, analyze the condition with scientific knowledge, provide the patient with information of hope and assurance of great help, and at the same time mobilize the strength of the family to do ideological work and serve her carefully to arouse her courage and confidence to survive.
Second, the indications for breast reconstruction surgery
(1) Congenital dysplasia of the breast;
(2) After simple mastectomy for benign breast tumor;
(3) No serious cardiopulmonary disease;
(4) No metastatic lesions and no local recurrence after various adjuvant examinations
(5) Good wound healing status after radical breast cancer surgery;
(6) Married women who have children or do not plan to have children
Contraindications
(1) Those with organic diseases of important organs or systemic diseases that cannot tolerate surgery;
(2) Patients with severe scarring.
(3) Patients with disorders of coagulation mechanism.
(4) Patients with signs of tumor recurrence or metastasis.
IV. Timing of breast reconstruction
(1) Immediate breast reconstruction: mastectomy and breast reconstruction should be completed at one time.
(2) Postponed breast reconstruction: six months after mastectomy, or after the skin elasticity of the radiotherapy area is restored if there is radiotherapy.
V. Classification of breast reconstruction
(1) Rectus abdominis muscle flap breast reconstruction
At present, there are more clinical applications of rectus abdominis muscle flap breast reconstruction. This procedure has the following advantages: the soft tissue of the patient’s own abdomen is used to reconstruct the breast, the softness of the breast is natural, the shape is maintained for a long time, and no rejection will occur; this procedure solves the problem of tension of the incision, and accordingly plays the role of abdominal weight loss; thoracic and abdominal surgery can be performed jointly; there is abundant tissue available in the abdomen, and it can even be used to reconstruct the breast at the same time after bilateral breast cancer surgery.
(2) Latissimus dorsi muscle flap breast reconstruction
It is a method of transferring and transplanting the latissimus dorsi muscle flap and skin island together to reconstruct the breast.
(3) Implant placement
Breast implant placement. If the patient has enough skin and pectoralis major muscle, the implant placement can provide direct and satisfactory results, and is safe and simple.
(4) Breast Reduction
Breast reduction surgery is a type of plastic surgery technique that involves removing part of the breast skin and breast tissue to reduce the breast shape and to reshape the nipple and areola. Reduction mammaplasty is used for overdeveloped breasts, i.e., enlarged breasts and sagging breasts.