Chen Ying, Chen Jiajian, Chen Jiaying, Yang Benlong, Li Lin, Huang Xiaoyan, Shao Zhimin, Shen Zhenzhou, Yu Peirong, Wu Jiong
Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Zhonghua Zhong Liu Za Zhi. 2014 Nov;36(11):851-7.
To explore the current trends of breast reconstruction (BR) for breast cancer patients in China.
A questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail.
By July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22.9%) were qualified to perform BR. In 2012, except for 4 missing data, 24, 763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) performed prosthetic (1, 843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25.0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.
With more attention paid to the quality of life after mastectomy, more and more BRs are needed, but the ratio is still low in China. To improve this situation, more efforts are needed, including the improvement of the intrahospital framework of multi-disciplinary service, the training for doctors and the educational program for patients, etc.
探讨中国乳腺癌患者乳房重建（BR）的当前趋势。
本研究设计了一份问卷，包括有关外科医生人口统计学、乳房切除术和乳房重建的数量、乳房重建的类型和时机、术前或术后放疗或化疗情况下的重建选择等问题。所有数据收集至2012年12月。问卷通过电子邮件或邮寄方式发送给乳腺癌协会委员会的52名成员。
截至2013年7月，共返回41份问卷。其中，5份因未开展乳房重建而被排除。这36家医院覆盖中国22个省和直辖市。共有538名从事普通外科或肿瘤外科的外科医生，但只有123名（22.9%）有资格进行乳房重建。2012年，除4个缺失数据外，32家医院共进行了24763例乳房切除术；其中，1120例（4.5%）接受了乳房重建。根据这36名受访者的反馈，从首次乳房重建手术至2012年底，32名（88.9%）进行了假体植入乳房重建（共1843例），4名（11.1%）进行了脱细胞真皮基质联合假体乳房重建（共17例）。同期，23家（63.9%）医院进行了965例背阔肌肌皮瓣联合假体乳房重建，32家（88.9%）医院进行了738例不带假体的背阔肌肌皮瓣乳房重建。同时，28家（77.8%）医院进行了366例带蒂腹直肌肌皮瓣乳房重建，9家（25.0%）医院进行了155例游离腹直肌肌皮瓣乳房重建。总体并发症发生率为18.2%。术后放疗对乳房重建的美学效果有一定影响，因此推荐自体乳房重建，但时机仍存在争议。关于化疗，大多数受访者认为其无影响或影响轻微。重建乳房的总体美容效果令大多数医生和患者满意。
随着对乳房切除术后生活质量的关注度提高，乳房重建的需求越来越大，但在中国该比例仍然较低。为改善这种情况，需要做出更多努力，包括完善医院内多学科服务框架、医生培训以及患者教育项目等。
