McManus Penny, Sterne Guy D, Fatah Fazel, Lee Martin J R
Department of General Surgery, City Hospital, Dudley Road, Birmingham B18 7QH, UK.
Br J Plast Surg. 2003 Sep;56(6):567-70. doi: 10.1016/s0007-1226(03)00221-2.
Immediate reconstruction (IR) of the breast following mastectomy is not available to all appropriate patients. Previous studies have examined general surgeons attitudes toward reconstruction but have not assessed how these translate into surgical practice. We investigated the current rates of referral for, and availability of, IR across the West Midlands region.A postal questionnaire was sent to all breast surgery units in the region. Out of 20 units 19 responded. Units where IR was performed in-house were likely to have more breast surgeons (2.3 vs. 1.5, p=0.0106), and a higher annual workload (222 new cases vs. 174). Only two of 19 surgeons said they did not discuss IR with appropriate patients. Selection criteria in the other units included age, lack of co-morbidity, favourable pathology, smoking habit, and in one unit, only small-breasted women were offered IR. IR is performed in 13 of 19 units. Reconstructive procedures range from implants to deep inferior epigastric artery perforator (DIEP) flaps; the surgery is performed by breast and plastic surgeons together in seven units, breast surgeons alone in five and plastic surgeons alone in one. Six units do not carry out reconstruction. These units referred between two and 10 patients (average five) for IR in 2001. Units where some types of IR were available referred between three and 35 patients for surgery not performed in-house, and there was no relationship between complexity of surgery available in-house and referral rates. Reasons for low referral rates included: surgeons' attitudes; geographical isolation; long waiting times for plastic surgical opinion and for surgery; and loss of control of patients' management. Although surgeons' attitudes in the West Midlands are generally positive toward IR, availability and referral rates vary widely. Reconstructive surgeons should encourage referrals by increasing contact with general surgeons to overcome logistical problems and by ensuring appropriate systems for referral exist.
乳房切除术后立即进行乳房重建（IR）并非适用于所有合适的患者。以往的研究调查了普通外科医生对重建手术的态度，但未评估这些态度如何转化为实际手术操作。我们调查了西米德兰兹地区当前IR的转诊率和可及性。向该地区所有乳房手术科室发送了邮政问卷。20个科室中有19个做出了回应。内部开展IR的科室可能拥有更多的乳房外科医生（2.3名对1.5名，p = 0.0106），且年工作量更高（222例新病例对174例）。19名外科医生中只有两名表示他们不会与合适的患者讨论IR。其他科室的选择标准包括年龄、无合并症、病理结果良好、吸烟习惯，在一个科室中，仅为乳房较小的女性提供IR。19个科室中有13个开展IR。重建手术方式从植入物到腹壁下深动脉穿支（DIEP）皮瓣不等；七个科室由乳房外科医生和整形外科医生共同进行手术，五个科室仅由乳房外科医生进行手术，一个科室仅由整形外科医生进行手术。六个科室不开展重建手术。这些科室在2001年将两到十名患者（平均五名）转诊进行IR。开展某些类型IR的科室将三到35名患者转诊进行科室内部未开展的手术，科室内部可开展手术的复杂程度与转诊率之间没有关联。转诊率低的原因包括：外科医生的态度；地理位置偏远；等待整形外科会诊和手术的时间过长；以及对患者管理失去控制。尽管西米德兰兹地区的外科医生对IR总体态度积极，但可及性和转诊率差异很大。重建外科医生应通过增加与普通外科医生的联系以克服后勤问题，并确保存在适当的转诊系统来鼓励转诊。
