瘦患者乳房重建后的患者报告满意度和生活质量：显微外科手术与假体植入受者的比较
Patient-Reported Satisfaction and Quality of Life following Breast Reconstruction in Thin Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients.
作者信息
Weichman Katie E, Broer P Niclas, Thanik Vishal D, Wilson Stelios C, Tanna Neil, Levine Jamie P, Choi Mihye, Karp Nolan S, Hazen Alexes
机构信息
Bronx, New York, and New Hyde Park, N.Y.; and Munich, Germany From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine; the Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen Teaching Hospital, Technical University Munich; the Department of Plastic Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Hosftra University/North Shore Long Island Jewish Medical Center.
出版信息
Plast Reconstr Surg. 2015 Aug;136(2):213-220. doi: 10.1097/PRS.0000000000001418.
BACKGROUND
Patients undergoing autologous breast reconstruction have higher long-term satisfaction rates compared with those undergoing prosthetic reconstruction. Regardless, most patients still undergo prosthetic reconstruction. The authors compared outcomes of microsurgical reconstruction to those of prosthetic reconstruction in thin patients and evaluated the effect of reconstructive type on quality of life.
METHODS
After institutional review board approval was obtained, the authors reviewed all patients undergoing breast reconstruction at a single institution from November of 2007 to May of 2012. Thin patients (body mass index <22 kg/m) were included for analysis and divided into two cohorts: microsurgical reconstruction and tissue expander/implant reconstruction. Once identified, patients were mailed a BREAST-Q survey for response; a retrospective chart review was also conducted.
RESULTS
A total of 273 patients met inclusion criteria: 81.7 percent (n = 223) underwent tissue expander/implant reconstruction and 18.3 percent (n = 50) underwent microsurgical reconstruction. Of the patients undergoing microsurgical reconstruction, 50 percent (n = 25) responded to the BREAST-Q survey, whereas 48.4 percent of patients (n = 108) with implant reconstruction were responders. Microsurgical patients required more secondary revision [48 percent (n = 12) versus 25.9 percent (n = 28)] and autologous fat grafting [32 percent (n = 8) versus 16.9 percent (n = 19)] and a greater volume of fat per injection (147.85 ml versus 63.9 ml; p < 0.001). Furthermore, BREAST-Q responses showed that these patients were more satisfied with their breasts (71.1 percent versus 64.9 percent; p = 0.004), but had similar overall satisfaction with reconstruction (73.0 percent versus 74.8 percent; p = 0.54).
CONCLUSIONS
Microsurgical breast reconstruction is efficacious in patients with a body mass index less than 22 kg/m and, when compared with prosthetic reconstruction, results in higher satisfaction with breasts. However, it requires more secondary revision surgery and the use of autologous fat grafting as an adjunct.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
与接受假体乳房重建的患者相比，接受自体乳房重建的患者长期满意度更高。尽管如此，大多数患者仍选择假体乳房重建。作者比较了瘦患者显微外科重建与假体重建的结果，并评估了重建类型对生活质量的影响。
方法
在获得机构审查委员会批准后，作者回顾了2007年11月至2012年5月在单一机构接受乳房重建的所有患者。纳入瘦患者（体重指数<22kg/m²）进行分析，并分为两个队列：显微外科重建和组织扩张器/植入物重建。一旦确定，就向患者邮寄BREAST-Q调查问卷以供回复；还进行了回顾性病历审查。
结果
共有273例患者符合纳入标准：81.7%（n = 223）接受了组织扩张器/植入物重建，18.3%（n = 50）接受了显微外科重建。在接受显微外科重建的患者中，50%（n = 25）回复了BREAST-Q调查问卷，而接受植入物重建的患者中有48.4%（n = 108）进行了回复。显微外科重建的患者需要更多的二次修复[48%（n = 12）对25.9%（n = 28）]和自体脂肪移植[32%（n = 8）对16.9%（n = 19）]，且每次注射的脂肪量更大（147.85ml对63.9ml；p<0.001）。此外，BREAST-Q的回复显示，这些患者对乳房更满意（71.1%对64.9%；p = 0.004），但对重建的总体满意度相似（73.0%对74.8%；p = 0.54）。
结论
显微外科乳房重建对体重指数小于22kg/m²的患者有效，与假体重建相比，患者对乳房的满意度更高。然而，它需要更多的二次修复手术，并使用自体脂肪移植作为辅助手段。
临床问题/证据水平：治疗性，III级。
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