Bodin F, Zink S, Lutz J-C, Kadoch V, Wilk A, Bruant-Rodier C
Service de chirurgie plastique reconstructrice et esthétique, hôpital civil, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
Ann Chir Plast Esthet. 2010 Dec;55(6):547-52. doi: 10.1016/j.anplas.2010.09.013. Epub 2010 Oct 30.
Patient satisfaction is a good indicator to evaluate the success of breast reconstruction. The aim of this study was to compare the long-term satisfaction in patients who underwent four breast reconstruction techniques.
Self-evaluation was achieved by patients in 147 breast reconstructions using a four-point score: very disappointed, disappointed, satisfied and very satisfied. The mean follow-up was 5.3 year (1 to 21.5 year). The surgical procedures used were: transverse rectus abdominis myocutaneous flap (TRAM) 15%, autologous latissimus dorsi flap (ALD) 14%, latissimus dorsi flap with implant (LDI) 32% and implant alone 39%. Patients' satisfaction was compared regarding the type of surgical procedure, the postoperative follow-up time; the immediate or delayed breast reconstruction and the radiation history.
Thirty-five percent of the patients were very satisfied with their operation, 54% were satisfied, 7% were disappointed and 4% very disappointed. After a 5-year follow-up, autologous flaps showed better results (P<0.001). Patients were more satisfied with TRAM flaps than with surgical techniques using latissimus dorsi flaps (ALD and LDI). Patients treated with implants alone were statistically less satisfied. Only in the implant series, patient satisfaction decreased significantly with time (P<0.001) and preoperative radiation (P=0.005).
Flap-based breast reconstructions show consistent long-term satisfaction although the surgery is initially more demanding. Our study matches the latest trends in the use of free perforator flaps for breast reconstruction. Indeed, these procedures combine good satisfaction and minor sequelae at the donor site.
患者满意度是评估乳房重建手术成功与否的一个良好指标。本研究的目的是比较接受四种乳房重建技术的患者的长期满意度。
147例接受乳房重建手术的患者通过四点评分法进行自我评估：非常失望、失望、满意和非常满意。平均随访时间为5.3年（1至21.5年）。所采用的手术方法有：横行腹直肌肌皮瓣（TRAM）15%，背阔肌自体皮瓣（ALD）14%，背阔肌皮瓣联合植入物（LDI）32%，单纯植入物39%。比较了患者对手术方式、术后随访时间、即刻或延期乳房重建以及放疗史的满意度。
35%的患者对手术非常满意，54%的患者满意，7%的患者失望，4%的患者非常失望。经过5年的随访，自体皮瓣显示出更好的效果（P<0.001）。患者对TRAM皮瓣的满意度高于使用背阔肌皮瓣（ALD和LDI）的手术技术。单纯接受植入物治疗的患者在统计学上满意度较低。仅在植入物系列中，患者满意度随时间（P<0.001）和术前放疗（P=0.005）显著下降。
尽管基于皮瓣的乳房重建手术最初要求更高，但显示出持续的长期满意度。我们的研究与使用游离穿支皮瓣进行乳房重建的最新趋势相符。事实上，这些手术方式在供区满意度高且后遗症少。
