Fitzpatrick Aisling M, Gao Lin Lin, Smith Barbara L, Cetrulo Curtis L, Colwell Amy S, Winograd Jonathan M, Yaremchuk Michael J, Austen William G, Liao Eric C
From the *Division of Plastic and Reconstructive Surgery, †Division of Surgical Oncology, Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School; and ‡Center for Regenerative Medicine, Harvard Stem Cell Institute, Boston, MA.
Ann Plast Surg. 2014 Aug;73(2):141-9. doi: 10.1097/SAP.0b013e318276d979.
Increased bilateral mastectomy for breast cancer treatment has generated an increased demand for bilateral breast reconstruction. This study examines changing patterns of reconstruction over the last decade to accommodate increased case volume and decreased morbidity associated with reconstruction. A single institution series of 3171 consecutive breast reconstruction cases of more than 10 years was divided into 2 periods, that is, 1999 to 2004 and 2005 to 2010. Bilateral breast reconstruction case volume increased 260% from 1999 to 2004 (n = 237) to 2005 to 2010 (n = 634). Mean patient age at diagnosis decreased by 7 years (P < 0.001). In 2005 to 2010, autologous reconstruction decreased from 60% to 26%, implant-based reconstruction increased from 40% to 74%. There was a noted increase in single-stage implant reconstruction and selective application of perforator flaps for bilateral autologous reconstruction (P < 0.001). Two-staged tissue expander reconstruction accounted for the greatest share of total cost (45%) in the later period. A younger patient demographic and increased case volume were accommodated through increased single-staged and prosthesis-based procedures.
因乳腺癌治疗而增加的双侧乳房切除术导致了对双侧乳房重建的需求增加。本研究调查了过去十年中重建模式的变化，以适应病例数量的增加和与重建相关的发病率的降低。一个单一机构连续10多年的3171例乳房重建病例系列被分为两个时期，即1999年至2004年和2005年至2010年。双侧乳房重建病例数量从1999年至2004年的237例增加了260%，达到2005年至2010年的634例。诊断时的平均患者年龄下降了7岁（P < 0.001）。在2005年至2010年，自体组织重建从60%降至26%，假体植入重建从40%增至74%。一期假体植入重建以及在双侧自体组织重建中选择性应用穿支皮瓣有显著增加（P < 0.001）。两期组织扩张器重建在后期占总成本的最大份额（45%）。通过增加一期手术和基于假体的手术，适应了更年轻的患者群体和增加的病例数量。
