Kamali Parisa, Paul Marek A, Ibrahim Ahmed M S, Koolen Pieter G L, Wu Winona, Schermerhorn Marc L, Lee Bernard T, Lin Samuel J
From the *Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †T. Marciniak Lower Silesian Specialist Hospital, Wroclaw, Poland; ‡Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; §Department of Plastic and Reconstructive Surgery, VU Medical Center, Amsterdam, the Netherlands; and ∥Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2017 Jun;78(6):717-722. doi: 10.1097/SAP.0000000000000963.
The incidence of breast cancer (BC) cases has increased significantly. The number of breast reconstruction (BR) procedures performed has mirrored this trend. Although implant-only procedures remain the most commonly used type of immediate BR, autologous techniques involving donor sites account for approximately 20%. The aim of this study was to assess national and regional trends in different types of autologous BR.
Using the Nationwide Inpatient Sample database (2008 to 2012), data on BC and mastectomy rates, type of autologous BR, and sociodemographics were obtained and analyzed. Furthermore, national and regional trends over time for autologous BR were plotted and analyzed.
A total of 427,272 patients diagnosed with BC or at increased risk of BC were included in the study. A total of 343,163 (80.3%) patients underwent mastectomy and, within this group, 148,700 (43.3%) patients underwent immediate BR. Of these, 32,249 (21.7%) patients underwent an autologous BR (not solely implant based) and 118,258 (78.3%) implant-based BR. Most autologous BRs were performed in the Southern region (37.4%). When stratified into flap types, most pedicled transverse rectus abdominis muscle (TRAM), free TRAM, and other flaps were performed in the Northeast region, whereas most deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps were performed in the Southern region. Subgroup analysis demonstrated a significant increasing trend for both LD and DIEP flaps, both nationally (P < 0.001) and regionally (P < 0.001). Pedicled TRAM and free TRAM reconstructions decreased significantly both on national and regional level.
Autologous BR demonstrated a significant positive trend over time in the Southern region (P < 0.001). The DIEP and LD flaps increased significantly over time, both nationally and regionally.
乳腺癌（BC）病例的发病率显著增加。乳房重建（BR）手术的数量也呈现出这一趋势。尽管单纯植入手术仍然是最常用的即刻乳房重建类型，但涉及供区的自体技术约占20%。本研究的目的是评估不同类型自体乳房重建的全国和地区趋势。
利用全国住院患者样本数据库（2008年至2012年），获取并分析了乳腺癌和乳房切除术率、自体乳房重建类型以及社会人口统计学数据。此外，还绘制并分析了自体乳房重建随时间的全国和地区趋势。
本研究共纳入427272例被诊断为乳腺癌或乳腺癌风险增加的患者。共有343163例（80.3%）患者接受了乳房切除术，在该组中，148700例（43.3%）患者接受了即刻乳房重建。其中，32249例（21.7%）患者接受了自体乳房重建（并非单纯基于植入物），118258例（78.3%）患者接受了基于植入物的乳房重建。大多数自体乳房重建手术在南部地区进行（37.4%）。当按皮瓣类型分层时，大多数带蒂腹直肌肌皮瓣（TRAM）、游离TRAM皮瓣和其他皮瓣在东北地区进行，而大多数腹壁下深动脉穿支（DIEP）皮瓣和背阔肌（LD）皮瓣在南部地区进行。亚组分析显示，LD皮瓣和DIEP皮瓣在全国（P<0.001）和地区（P<0.001）均呈现显著增加趋势。带蒂TRAM皮瓣和游离TRAM皮瓣重建在全国和地区层面均显著减少。
随着时间的推移，自体乳房重建在南部地区呈现出显著的上升趋势（P<0.001）。DIEP皮瓣和LD皮瓣在全国和地区均随时间显著增加。
