New York, N.Y. From the Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center.
Plast Reconstr Surg. 2013 Mar;131(3):320e-326e. doi: 10.1097/PRS.0b013e31827cf576.
The aims of the current study were to (1) measure trends in the type of mastectomy performed, (2) evaluate sociodemographic/hospital characteristics of patients undergoing contralateral prophylactic mastectomy versus unilateral mastectomies, and (3) analyze reconstruction rates and method used following different mastectomy types.
Mastectomies from 1998 to 2008 were analyzed using the Nationwide Inpatient Sample database. Mastectomies (n = 178,603) were classified as either unilateral, contralateral prophylactic, or bilateral prophylactic. Reconstructive procedures were categorized into either implant or autologous. Longitudinal trends were analyzed with Poisson regression and sociodemographic/hospital variables were analyzed with logistic regression.
Unilateral mastectomies decreased 2 percent per year, whereas contralateral and bilateral prophylactic mastectomies increased significantly by 15 and 12 percent per year, respectively (p < 0.01). Independent predictors for contralateral prophylactic mastectomy (compared with unilateral mastectomy) were patients younger than 39 years, Caucasian and Hispanic race, private insurance carriers, treated in teaching hospitals, and from South and Midwest regions. Contralateral prophylactic mastectomy is the only group with increased reconstruction rates throughout the study period (p < 0.01). Although implant use increased for all mastectomy types, it remains greater in bilateral and contralateral prophylactic mastectomy.
There is increasing use of bilateral mastectomies in the United States, particularly in patients with unilateral cancer. Although implant use has increased for all mastectomy types, they are used most commonly following bilateral and contralateral prophylactic mastectomies. Changing mastectomy patterns are one factor underlying the paradigm shift away from autologous tissue to implant-based reconstruction.
本研究的目的是：（1）测量所行乳房切除术类型的趋势；（2）评估行对侧预防性乳房切除术与单侧乳房切除术的患者的社会人口学/医院特征；（3）分析不同乳房切除术类型后的重建率和方法。
使用全国住院患者样本数据库分析 1998 年至 2008 年的乳房切除术。将乳房切除术（n=178603）分为单侧、对侧预防性或双侧预防性。重建手术分为植入物或自体组织。采用泊松回归分析纵向趋势，采用逻辑回归分析社会人口学/医院变量。
单侧乳房切除术每年减少 2%，而对侧和双侧预防性乳房切除术则分别显著增加 15%和 12%（p<0.01）。与单侧乳房切除术相比，对侧预防性乳房切除术的独立预测因子为：年龄小于 39 岁、白种人和西班牙裔、私人保险、在教学医院治疗、来自南部和中西部地区。对侧预防性乳房切除术是唯一一组在整个研究期间重建率增加的人群（p<0.01）。尽管所有乳房切除术类型的植入物使用率都有所增加，但在双侧和对侧预防性乳房切除术中的使用率更高。
美国双侧乳房切除术的使用日益增加，尤其是在单侧癌症患者中。尽管所有乳房切除术类型的植入物使用率都有所增加，但它们在双侧和对侧预防性乳房切除术中的使用最为常见。乳房切除术模式的变化是从自体组织向植入物为基础的重建转变的范式转变的一个因素。
