Ng Sally K, Hare Rowena M, Kuang Ronny J, Smith Katrina M, Brown Belinda J, Hunter-Smith David J
From the *Departments of Plastic and Reconstructive Surgery and †Surgery, Peninsular Health, Victoria; and ‡Peninsula and Gippsland Clinical Schools, Monash University, Victoria, Australia.
Ann Plast Surg. 2016 Jun;76(6):640-4. doi: 10.1097/SAP.0000000000000242.
Although breast reconstruction has been shown to improve psychological, physical, and sexual well-being, Australia still has one of the lowest reconstruction rates among well-developed countries. This study explores both the quality-of-life benefits of reconstruction and the factors that influence patients' decisions of whether or not to undergo reconstruction.
This retrospective cohort study (296 consecutive mastectomy patients from 2000 to 2010) uses an internationally validated questionnaire (BREAST-Q) to evaluate patients' satisfaction with or without breast reconstruction. In addition, we analyzed factors that influence patients' decisions of whether to undergo reconstruction.
Two hundred nineteen patients responded (74%) and of the 143 patients who elected to participate, 79 were in the "reconstruction group" and 64 in the "no-reconstruction group" post mastectomy. Patient demographics and cancer variables of the 2 groups were matched with the exception of age (reconstruction group 9.7 years younger: P < 0.01). The reconstruction group showed statistically significantly higher BREAST-Q scores with regard to satisfaction with the breast (P < 0.0001), psychological well-being (P = 0.0068), and sexual well-being (P = 0.0001). For the reconstruction group, the main reasons for undergoing reconstruction included improved self-image, more clothing choices, and the feeling of overcoming the cancer. One third of non-reconstructed patients still feared that reconstruction would mask cancer recurrence.
Our study confirms the positive effects of breast reconstruction post mastectomy and identifies reasons that influence patients' decisions of whether to undergo reconstruction. Breast reconstruction should be seen as an integral part in the comprehensive care of women with breast cancer and an important health care priority in Australia.
尽管乳房重建已被证明能改善心理、身体和性健康状况，但在发达国家中，澳大利亚的乳房重建率仍处于较低水平。本研究探讨了乳房重建对生活质量的益处以及影响患者决定是否接受重建的因素。
这项回顾性队列研究（2000年至2010年间连续纳入的296例乳房切除术患者）使用了经过国际验证的问卷（BREAST-Q）来评估患者对乳房重建与否的满意度。此外，我们分析了影响患者决定是否接受重建的因素。
219例患者做出了回应（回应率74%），在143例选择参与的患者中，79例在乳房切除术后进入“重建组”，64例进入“未重建组”。除年龄外（重建组年轻9.7岁：P<0.01），两组患者的人口统计学和癌症变量相匹配。重建组在乳房满意度（P<0.0001）、心理健康（P=0.0068）和性健康（P=0.0001）方面的BREAST-Q评分在统计学上显著更高。对于重建组，接受重建的主要原因包括自我形象改善、更多服装选择以及战胜癌症的感觉。三分之一未接受重建的患者仍担心重建会掩盖癌症复发。
我们的研究证实了乳房切除术后乳房重建的积极效果，并确定了影响患者决定是否接受重建的原因。乳房重建应被视为乳腺癌女性综合护理的一个组成部分，也是澳大利亚重要的医疗保健重点。
