Gurunluoglu Raffi, Gurunluoglu Aslin, Williams Susan A, Tebockhorst Seth
Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences, Denver, Colorado 80204, USA.
Ann Plast Surg. 2013 Jan;70(1):103-10. doi: 10.1097/SAP.0b013e31822ed5ce.
We conducted a retrospective survey of American Society of Plastic Surgeons to ascertain the current trends in breast reconstruction (BR).
Surveys were sent to 2250 active American Society of Plastic Surgeons members by e-mail with a cover letter including the link using Survey Monkey for the year 2010. In all, 489 surveys (a response rate of 21.7%) were returned. Three hundred fifty-eight surveys from respondents performing BR in their practices were included in the study. The survey included questions on surgeon demographics, practice characteristics, BR after mastectomy, number of BR per year, type and timing of BR, use of acellular dermal matrix, reconstructive choices in the setting of previous irradiation and in patients requiring postmastectomy radiation therapy, timing of contralateral breast surgery, fat grafting, techniques used for nipple-areola reconstruction, the complications, and physician satisfaction and physician reported patient satisfaction. Returned responses were tabulated and assessed.
After prophylactic mastectomy, 16% of BRs were performed. In all, 81.2% of plastic surgeons predominantly performed immediate BR. In patients requiring postmastectomy radiation therapy, 81% did not perform immediate BR. Regardless of practice setting and laterality of reconstruction, 82.7% of respondents predominantly performed implant-based BR. Half of the plastic surgeons performing prosthetic BR used acellular dermal matrix. Only 14% of plastic surgeons predominantly performed autologous BR. Surgeons in solo, plastic surgery group practices, and multispecialty group practices preferred implant-based BR for both unilateral and bilateral cases more frequently than those in academic practices (P < 0.05). Overall, plastic surgeons in academic settings preferred autologous BR more frequently than those in other practice locations (P < 0.05). Of total respondents, 64.8% did not perform microsurgical BR at all; 28% reported performing deep inferior epigastric perforator flap BR. Pedicled transverse rectus abdominis myocutaneous flap was the most often used option for unilateral autologous reconstruction, whereas deep inferior epigastric perforator flap was the most commonly used technique for bilateral BR. The overall complication rate reported by respondents was 11%.
The survey provides an insight to the current trends in BR practice with respect to surgeon and practice setting characteristics. Although not necessarily the correct best practices, the survey does demonstrate a likely portrayal of what is being practiced in the United States in the area of BR.
我们对美国整形外科医师协会进行了一项回顾性调查，以确定乳房重建（BR）的当前趋势。
通过电子邮件向2250名美国整形外科医师协会的活跃会员发送调查问卷，并附上一封包含2010年使用Survey Monkey链接的求职信。总共收到489份调查问卷（回复率为21.7%）。研究纳入了358份来自在其临床实践中进行乳房重建的受访者的调查问卷。该调查包括有关外科医生人口统计学、临床实践特征、乳房切除术后的乳房重建、每年乳房重建的数量、乳房重建的类型和时间、脱细胞真皮基质的使用、既往接受过放疗的患者以及需要乳房切除术后放疗的患者的重建选择、对侧乳房手术的时间、脂肪移植、乳头乳晕重建所使用的技术、并发症以及医生满意度和医生报告的患者满意度等问题。对返回的回复进行列表整理和评估。
在预防性乳房切除术后，进行了16%的乳房重建。总体而言，81.2%的整形外科医生主要进行即刻乳房重建。在需要乳房切除术后放疗的患者中，81%没有进行即刻乳房重建。无论临床实践环境和重建的侧别如何，82.7%的受访者主要进行基于植入物的乳房重建。进行假体乳房重建的整形外科医生中有一半使用了脱细胞真皮基质。只有14%的整形外科医生主要进行自体乳房重建。与学术机构的医生相比，独立执业、整形外科团体执业和多专科团体执业的医生在单侧和双侧病例中更倾向于使用基于植入物的乳房重建（P < 0.05）。总体而言，学术机构的整形外科医生比其他临床实践地点的医生更频繁地选择自体乳房重建（P < 0.05）。在所有受访者中，64.8%根本没有进行显微外科乳房重建；28%报告进行了腹壁下深动脉穿支皮瓣乳房重建。带蒂腹直肌肌皮瓣是单侧自体重建最常用的选择，而腹壁下深动脉穿支皮瓣是双侧乳房重建最常用的技术。受访者报告的总体并发症发生率为11%。
该调查提供了关于乳房重建临床实践中外科医生和临床实践环境特征的当前趋势的见解。尽管不一定是正确的最佳实践，但该调查确实展示了美国在乳房重建领域正在实践的情况的可能写照。
