Brennan Meagan E, Flitcroft Kathy, Warrier Sanjay, Snook Kylie, Spillane Andrew J
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia.
Academic Institute, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
Breast. 2016 Dec;30:59-65. doi: 10.1016/j.breast.2016.08.008. Epub 2016 Sep 7.
Immediate tissue expander/implant-based breast reconstruction (BR) is often avoided when post-mastectomy radiotherapy (PMRT) is planned due to concerns about high complication rates and poor aesthetic outcomes. This study evaluated surgical, aesthetic and quality of life (QoL) outcomes in women undergoing immediate implant-based BR (IIBR) followed by PMRT.
Participants were recruited at least six months after completing the final stage of BR. They completed validated on-line questionnaires assessing satisfaction, QoL, distress, body image and regret. Aesthetic outcomes were rated by their operating surgeon through clinical examination and assessed by an independent surgeon using photographs.
Forty-seven participants completed questionnaires and reported good outcomes for QoL (FACT-B = 115; TOI = 73), satisfaction (Breast-Q), distress (Impact of Events scale <4.8 all subscales) and body image (Body Image scale), with a low score on the Decisional Regret scale (mean 12.1). Aesthetic outcomes were rated fair-to-good (Kroll scale). The surgical complication rate was low (expander/implant loss rate 6.4%, wound infection 10.6%, seroma 4.1%). At follow-up, 33 (70.2%) participants retained their permanent implant and 12 (25.5%) converted to a TRAM or DIEP flap; there were two LD flaps.
This study demonstrated acceptable cosmetic results, high patient satisfaction and low complication rates. It provides evidence that women are willing to accept the potential risks of IIBR in exchange for its benefits including enhanced body image during chemotherapy and PMRT and the possible avoidance of more complicated and costly delayed autologous BR. The results support the importance of access to BR, even in women with high-risk disease.
由于担心并发症发生率高和美学效果不佳，在计划进行乳房切除术后放疗（PMRT）时，通常会避免立即进行基于组织扩张器/植入物的乳房重建（BR）。本研究评估了接受立即植入式BR（IIBR）并随后进行PMRT的女性的手术、美学和生活质量（QoL）结果。
参与者在完成BR最后阶段至少六个月后被招募。他们完成了经过验证的在线问卷，评估满意度、QoL、痛苦、身体形象和遗憾。美学结果由其手术医生通过临床检查进行评分，并由独立医生使用照片进行评估。
47名参与者完成了问卷，并报告了良好的QoL结果（FACT-B = 115；TOI = 73）、满意度（乳房-Q）、痛苦（事件影响量表所有子量表<4.8）和身体形象（身体形象量表），决策遗憾量表得分较低（平均12.1）。美学结果被评为中等至良好（克罗尔量表）。手术并发症发生率较低（扩张器/植入物丢失率6.4%，伤口感染10.6%，血清肿4.1%）。在随访中，33名（70.2%）参与者保留了永久性植入物，12名（25.5%）转换为TRAM或DIEP皮瓣；有2例背阔肌皮瓣。
本研究证明了可接受的美容效果、高患者满意度和低并发症发生率。它提供了证据表明，女性愿意接受IIBR的潜在风险，以换取其益处，包括在化疗和PMRT期间增强身体形象，以及可能避免更复杂和昂贵的延迟自体BR。结果支持了获得BR的重要性，即使是在患有高危疾病的女性中。
