Hamnett K E, Subramanian A
Department of Plastic Surgery, Whiston Hospital, Warrington Road, Prescot, Liverpool, L35 5DR, United Kingdom.
Department of Breast Surgery, East Sussex Healthcare NHS Trust, King's Dr, Eastbourne, East Sussex, BN21 2UD, United Kingdom.
J Plast Reconstr Aesthet Surg. 2016 Oct;69(10):1325-34. doi: 10.1016/j.bjps.2016.06.003. Epub 2016 Jun 17.
Women not undergoing breast reconstruction after mastectomy tend to be older. This review aims to aid in effective, evidence-based choices regarding breast reconstruction in an older population, appraising the influencing patient factors described in the literature and those directing the reconstructive surgeon. This may refute current misconceptions and ensure surgical decisions are made based on evidence without ageist assumptions. The review forms the basis of an evidence-based algorithm addressing each step of the decision-making process.
A literature search was conducted using PubMed, Medline, Evidence.nhs.uk and the Cochrane database. Search terms initially were breast reconstruction, mastectomy, elderly, older, decision, reasons and rationale. A separate literature search was performed for each of the individual 'steps' in the decision-making process.
Overall, 44 papers were obtained. For each section of the decision-making process, titles and abstracts were screened for relevance. Only English language papers were included.
If reconstruction is oncologically plausible and co-morbidities and frailty formally assessed, older women should be actively informed about breast reconstruction, receive support and engage in 'shared decision-making'. The older patient is less likely to do research independently. Amongst other factors, body image, cancer fears, employment and carer responsibilities play a part in the decision. With adequate preoperative and frailty assessment and early involvement of the geriatrician and anaesthetist, microsurgical reconstruction is safe. Autologous reconstruction has better long-term outcomes than implant-based reconstructions in this age group, correlating with improved survival and longevity of reconstruction. Age alone should not be considered a contraindication to breast reconstruction.
乳房切除术后未进行乳房重建的女性往往年龄较大。本综述旨在帮助在老年人群中就乳房重建做出有效、基于证据的选择，评估文献中描述的影响患者的因素以及指导重建外科医生的因素。这可能会驳斥当前的误解，并确保手术决策基于证据而非年龄歧视性假设。该综述构成了一个基于证据的算法的基础，该算法涉及决策过程的每一步。
使用PubMed、Medline、Evidence.nhs.uk和Cochrane数据库进行文献检索。最初的检索词为乳房重建、乳房切除术、老年人、年长、决策、原因和理由。对决策过程中的每个单独“步骤”进行了单独的文献检索。
总体而言，共获得44篇论文。对决策过程的每个部分，筛选标题和摘要以确定相关性。仅纳入英文论文。
如果重建在肿瘤学上可行且对合并症和身体虚弱进行了正式评估，应积极告知老年女性有关乳房重建的信息，给予支持并参与“共同决策”。老年患者独立进行研究的可能性较小。在其他因素中，身体形象、对癌症的恐惧、就业和照顾者责任在决策中起作用。通过充分的术前和身体虚弱评估以及老年病医生和麻醉医生的早期参与，显微外科重建是安全的。在这个年龄组中，自体组织重建比植入物重建具有更好的长期效果，这与重建的生存率提高和持久性相关。年龄本身不应被视为乳房重建的禁忌证。
