Academic Surgical Research Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Ann Surg Oncol. 2011 Mar;18(3):813-23. doi: 10.1245/s10434-010-1368-6. Epub 2010 Oct 23.
Breast reconstruction (BR) is undertaken to improve cosmetic outcomes, but how this is optimally assessed is uncertain. This review summarises current methods for assessing cosmesis after reconstructive surgery and makes recommendations for future practice.
A comprehensive systematic review identified all studies with 20 or more participants that evaluated the cosmetic outcome of BR. Four evaluation criteria (reporting of study inclusion criteria, type and timing of BR and timing of assessment) were used to assess study quality. Articles reporting at least three of the four criteria were considered robust and further summarised to report methods of cosmetic assessment, assessor details and the scoring systems used.
122 primary papers assessed cosmesis in 11,308 women with median follow-up of 28.8 months (range 18.0-42.9 months). Cosmesis was assessed by either healthcare professionals or patients in 33 (27.1%) and 37 studies (30.3%), respectively, and by both professionals and patients in 52 (42.6%). Professional assessments included 43 (40.2%) clinical, 49 (45.8%) photographic and 13 (12.1%) geometric assessments conducted by between 1 and 26 observers. Surgeons were most frequently involved in assessments (n = 71, 67.6%), but in 38 (36.1%) papers the assessor's profession was not reported. Twenty-seven (25.7%) papers used previously published assessment scale. Patients' views were assessed in 89 studies, using questionnaires (n = 63) or interviews (n = 12); 14 (15.7%) did not report how patients' views were obtained.
Current methods for assessing the cosmetic outcome of BR vary widely. A valid patient-centred assessment method is required to fully understand the outcomes of BR and to inform decision-making.
乳房重建（BR）旨在改善美容效果，但如何最佳评估这一点尚不确定。本综述总结了目前评估重建手术后美容效果的方法，并为未来的实践提出了建议。
全面的系统综述确定了所有纳入 20 名或以上参与者的研究，这些研究评估了 BR 的美容结果。使用四项评估标准（研究纳入标准的报告、BR 的类型和时机以及评估的时机）来评估研究质量。至少报告四项标准中的三项的文章被认为是可靠的，并进一步总结了美容评估方法、评估者详细信息和使用的评分系统。
122 篇主要论文评估了 11308 名女性的美容效果，中位随访时间为 28.8 个月（范围为 18.0-42.9 个月）。美容评估由医疗保健专业人员或患者进行，分别有 33 项（27.1%）和 37 项研究（30.3%），由专业人员和患者共同进行的有 52 项（42.6%）。专业评估包括 43 项（40.2%）临床评估、49 项（45.8%）摄影评估和 13 项（12.1%）几何评估，由 1 至 26 名观察者进行。外科医生最常参与评估（n=71，67.6%），但在 38 项（36.1%）论文中未报告评估者的职业。27 项（25.7%）论文使用了先前发表的评估量表。在 89 项研究中评估了患者的观点，使用问卷（n=63）或访谈（n=12）；14 项（15.7%）未报告如何获得患者的观点。
目前评估 BR 美容效果的方法差异很大。需要一种有效的以患者为中心的评估方法，以充分了解 BR 的结果并为决策提供信息。
