Department of Plastic Surgery, Breast Surgery and Burns Unit, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):1652-8. doi: 10.1016/j.bjps.2013.07.015. Epub 2013 Aug 2.
Few studies have examined the prevalence of persistent pain after breast reconstruction with an implant after tissue expansion in comparison to mastectomy without breast reconstruction. Our primary objective was to evaluate the prevalence of persistent pain after breast reconstruction with a subpectoral implant after tissue expansion in a population-based study. Secondary objectives were to evaluate sensory disturbances, lymphoedema and functional impairment.
This was a nationwide cross-sectional questionnaire study of breast cancer patients aged 18-69 years who were treated with or without reconstruction after mastectomy for primary breast cancer in Denmark between 1 January 2005 and 31 December 2006. The response rate was 84% for mastectomy without reconstruction and 83% for patients treated with breast reconstruction.
A total of 129 patients treated with mastectomy and breast reconstruction with a subpectoral implant were compared with 1131 patients treated with mastectomy without reconstruction. Prevalence of persistent pain for patients treated with mastectomy followed by reconstruction with an implant was 40% compared to 48% of patients treated only with mastectomy. We found no increased risk of persistent pain in patients having a reconstruction with an implant compared with mastectomy without reconstruction (odds ratio (OR) 0.82, 95% confidence interval (CI) 0.55-1.22, P=0.33) when adjusting for age, axillary procedure, radiotherapy and chemotherapy. We observed no difference in the prevalence of pain between patients treated with immediate or delayed breast reconstruction (P=0.116).
Breast reconstruction with a subpectoral implant after tissue expansion does not confer increased prevalence of persistent pain.
很少有研究比较组织扩张后假体乳房重建与单纯乳房切除术不重建的情况下，对乳房重建后持续性疼痛的发生率进行评估。我们的主要目的是在一项基于人群的研究中评估组织扩张后胸肌下假体乳房重建后持续性疼痛的发生率。次要目标是评估感觉障碍、淋巴水肿和功能障碍。
这是一项全国性的横断面问卷调查研究，纳入了 2005 年 1 月 1 日至 2006 年 12 月 31 日期间在丹麦接受或不接受乳房重建治疗的年龄在 18-69 岁的原发性乳腺癌患者。不接受重建的乳房切除术患者的应答率为 84%，接受乳房重建的患者的应答率为 83%。
共有 129 例接受乳房切除术和胸肌下假体乳房重建的患者与 1131 例仅接受乳房切除术的患者进行了比较。接受乳房切除术和假体乳房重建的患者持续性疼痛的发生率为 40%，而仅接受乳房切除术的患者为 48%。我们发现与单纯乳房切除术相比，接受假体乳房重建的患者持续性疼痛的风险没有增加（比值比（OR）0.82，95%置信区间（CI）0.55-1.22，P=0.33），同时调整了年龄、腋窝手术、放疗和化疗等因素。我们观察到即时或延迟乳房重建患者之间疼痛的发生率没有差异（P=0.116）。
组织扩张后胸肌下假体乳房重建不会增加持续性疼痛的发生率。
