Wang Howard T, Barone Constance M, Steigelman Megan B, Kahlenberg Morton, Rousseau Dennis, Berger Jamie, Daum Allison, Ortegon Delio P
Department of Surgery, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA.
Aesthet Surg J. 2008 Mar-Apr;28(2):165-70. doi: 10.1016/j.asj.2007.12.001.
Since the National Surgical Adjuvant Breast and Bowel Project B06 (NSABP-B06) trial demonstrated equivalent survival outcomes between patients with breast cancer undergoing modified radical mastectomy versus lumpectomy and radiation, an increasing number of patients are seeking breast conservation therapy. Traditionally, only patients who have undergone total mastectomy have been referred for reconstruction.
The purpose of the study was to determine the number of dissatisfied patients treated with breast conservation therapy who have suboptimal cosmesis and should be referred for reconstruction.
After obtaining approval from the Institutional Review Board and patient consent, patients identified as more than 1 year posttreatment from breast conservation therapy (1999-2004) were interviewed and photographed. Data were gathered by use of a questionnaire that included patient aesthetic score, patient satisfaction, and change in body image. Photographs were shown to a surgical oncologist, a general surgeon, and a plastic surgeon for a physician aesthetic score.
Thirteen of 46 patients (28.3%) were dissatisfied with their cosmetic result. Women who were dissatisfied with their cosmetic result were more likely to have a negative change in their body image when compared with patients who were satisfied with their cosmetic result (46.2 % vs 6.1%, P = .02). Additionally, dissatisfied patients were more likely to rate their cosmetic result as poor (15.4 % vs 0%, P = .007) and were more likely to consider reconstruction (46.2% vs 9.1%, P = .01) when compared with satisfied patients. Risk factors to predict dissatisfaction in our patient population included age younger than 52 years and the resection of tumor from the upper inner quadrant.
Twenty-eight percent of patients in this study were dissatisfied with their cosmetic result. Furthermore, a large portion of these patients would consider reconstruction if it were offered. Although this study only identified a few broad risk factors for suboptimal cosmetic outcome, it confirms our hypothesis that many patients who have undergone breast conservation therapy should be referred for plastic surgery consultation.
自从国家乳腺与肠道外科辅助治疗计划B06（NSABP - B06）试验表明，接受改良根治性乳房切除术的乳腺癌患者与接受乳房肿瘤切除术及放疗的患者生存率相当以来，越来越多的患者寻求保乳治疗。传统上，只有接受全乳切除术的患者才会被转诊进行乳房重建。
本研究的目的是确定接受保乳治疗但美容效果欠佳且应被转诊进行乳房重建的不满意患者数量。
在获得机构审查委员会批准并征得患者同意后，对确诊为保乳治疗后1年以上（1999 - 2004年）的患者进行访谈并拍照。通过使用包含患者美学评分、患者满意度和身体形象变化的问卷收集数据。将照片展示给外科肿瘤学家、普通外科医生和整形外科医生以获得医生美学评分。
46例患者中有13例（28.3%）对其美容效果不满意。与对美容效果满意的患者相比，对美容效果不满意的女性身体形象出现负面变化的可能性更大（46.2%对6.1%，P = 0.02）。此外，与满意的患者相比，不满意的患者更有可能将其美容效果评为差（15.4%对0%，P = 0.007），并且更有可能考虑进行乳房重建（46.2%对9.1%，P = 0.01）。在我们的患者群体中，预测不满意的风险因素包括年龄小于52岁以及肿瘤从上内象限切除。
本研究中28%的患者对其美容效果不满意。此外，如果提供乳房重建，这些患者中的很大一部分会考虑进行重建。虽然本研究仅确定了一些美容效果欠佳的广泛风险因素，但它证实了我们的假设，即许多接受保乳治疗的患者应被转诊进行整形外科咨询。
