Division of Plastic Surgery, Harlem Hospital, New York, NY 10032, USA.
J Am Coll Surg. 2012 Mar;214(3):270-6. doi: 10.1016/j.jamcollsurg.2011.11.014. Epub 2012 Jan 5.
Fewer than half of patients undergo reconstruction after breast cancer treatment, despite its quality of life benefits. Earlier studies demonstrated that most general surgeons do not discuss reconstructive options with patients. The aim of this study was to examine the likelihood of reconstruction within a cohort of mastectomy patients and compare rates of reconstruction between those referred and not referred for plastic surgery evaluation.
Retrospective review of the records of 471 consecutive patients between the ages of 19 and 94 years who underwent mastectomy between 2003 and 2007. Variables evaluated were age, body mass index, diabetes, laterality (unilateral vs bilateral), TNM staging, history of radiation, smoking history, insurance type, and race.
Of 471 patients, 313 were referred for consultation with a plastic surgeon and 158 were not; 91.7% of those referred were reconstructed and 100% of those not referred were not reconstructed. The 2 groups differed considerably in terms of age (mean age 61.84 years in the nonreferred group vs 51.83 years in the referred group), body mass index (25.9 in referred group, 27 in nonreferred group), diabetes (15% in nonreferred group vs 3.5% in referred group), and laterality (14% of nonreferred group underwent bilateral mastectomies vs 26% of those referred). The groups did not differ significantly in terms of race or tobacco use. Those with private insurance were more likely to be reconstructed, but no independent effect of insurance type was seen on multivariate analysis.
The breast surgeon's decision to refer a patient for reconstruction significantly affects whether the patient will receive breast reconstruction. Factors that appear to influence the referral decision are age, diabetes, body mass index, and laterality of mastectomy (bilateral more than unilateral).
尽管重建可以提高生活质量，但乳腺癌治疗后仅有不到一半的患者接受了重建。早期的研究表明，大多数普通外科医生不会与患者讨论重建选择。本研究旨在检查乳腺癌患者队列中接受重建的可能性，并比较接受和未接受整形手术评估的患者之间的重建率。
回顾性分析了 2003 年至 2007 年间接受乳房切除术的 471 例年龄在 19 至 94 岁之间的连续患者的记录。评估的变量包括年龄、体重指数、糖尿病、侧别（单侧与双侧）、TNM 分期、放疗史、吸烟史、保险类型和种族。
在 471 例患者中，有 313 例被转介给整形外科医生咨询，有 158 例未被转介；被转介的患者中有 91.7%接受了重建，而未被转介的患者中有 100%未接受重建。这两组在年龄（未转介组的平均年龄为 61.84 岁，转介组为 51.83 岁）、体重指数（转介组为 25.9，未转介组为 27）、糖尿病（未转介组为 15%，转介组为 3.5%）和侧别（未转介组 14%接受双侧乳房切除术，转介组为 26%）方面差异显著。种族或吸烟习惯两组间无显著差异。有私人保险的患者更有可能接受重建，但在多变量分析中，保险类型没有独立影响。
乳房外科医生决定转介患者进行重建显著影响患者是否接受乳房重建。影响转介决策的因素似乎是年龄、糖尿病、体重指数和乳房切除术的侧别（双侧多于单侧）。
