Stacey D Heath, Spring Michelle A, Breslin Tara M, Rao Venkat K, Gutowski Karol A
Division of Plastic and Reconstructive Surgery, University of Wisconsin-Madison, Madison, WI 53719, USA.
WMJ. 2008 Sep;107(6):292-7.
Breast reconstruction rates remain low, at 5%-15% of mastectomy patients, despite the safety and high patient satisfaction of these procedures. Reasons for this are multifactorial, including the attitudes and biases of the referring breast surgeon, as well as patient factors. The purpose of this study was to explore attitudes of general surgeons towards breast reconstruction.
We surveyed 369 general surgeons in Wisconsin with questions about breast surgery. Responses from 135 (36%) surgeons were analyzed.
Seventy-three percent of the respondents performed at least some breast surgery and were eligible for the study. For a little over 50% of the general surgeons surveyed, breast surgery made up less than 10% of their practice. Fifty-one percent never performed a skin-sparing mastectomy. A large number of breast surgeons (40%) did not refer all mastectomy patients for reconstruction. Reasons cited for not referring patients included the concerns over cancer recurrence and advanced patient age. Reasons for patients not undergoing reconstruction included patient's refusal, need for radiation therapy, delaying adjuvant oncologic treatment, patient factors, and having no plastic surgeon available locally.
The decision by a patient to undergo breast reconstruction involves many complex factors. As a specialty, we should focus on improving the availability of breast reconstructive surgeons and educating referring surgeons and patients about reconstructive indications and options in order to positively affect the utilization of breast reconstruction.
尽管乳房重建手术具有安全性且患者满意度高，但乳房重建率仍然很低，仅占乳房切除术患者的5%-15%。其原因是多方面的，包括主刀乳房外科医生的态度和偏见，以及患者自身因素。本研究的目的是探讨普通外科医生对乳房重建的态度。
我们对威斯康星州的369名普通外科医生进行了关于乳房手术的问卷调查。对135名（36%）医生的回复进行了分析。
73%的受访者至少进行过一些乳房手术，符合研究条件。在接受调查的普通外科医生中，略超过50%的医生乳房手术量占其业务量不到10%。51%的医生从未进行过保乳手术。大量乳房外科医生（40%）没有将所有乳房切除术患者转诊进行重建手术。不转诊患者的原因包括对癌症复发的担忧和患者年龄较大。患者不接受重建手术的原因包括患者拒绝、需要放疗、推迟辅助肿瘤治疗、患者自身因素以及当地没有整形外科医生。
患者决定接受乳房重建手术涉及许多复杂因素。作为一个专业领域，我们应专注于提高乳房重建外科医生的可及性，并对转诊医生和患者进行关于重建手术适应症和选择的教育，以便对乳房重建手术的利用率产生积极影响。
