Weissler Elizabeth H, Lamelas Andreas, Massenburg Benjamin B, Taub Peter J
Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Breast J. 2017 Nov;23(6):706-712. doi: 10.1111/tbj.12888. Epub 2017 Aug 22.
Much research has been devoted to why women choose not to be reconstructed following mastectomy. The effect of breast size has not been well explored. The authors aimed to assess the relationship between breast size and reconstructive choices. A single-center retrospective review of women undergoing mastectomy between 2011 and 2014 was performed. Demographics, surgical variables, and reconstruction decisions were analyzed using t tests, Mann-Whitney U tests, and chi-squared tests. Significant (P < .05) variables were included in a multivariable logistic regression model. About 610 patients were analyzed. The median mastectomy specimen weight was 572 g (62-5230 g), which did not correlate with BMI (P = .44). Women who underwent reconstruction had lighter mastectomy specimens, averaging 643 vs 848 g (P < .0001). A regression controlling for ethnicity, insurance status, number of comorbidities, age at mastectomy, cancer stage, BMI, specimen weight, and mastectomy laterality was constructed. Lower specimen weight (P = .005), lower cancer stage (P = .008), bilateral mastectomy (P = .042), and younger age at mastectomy (P < .0001) were significantly associated with reconstruction. Women with larger breasts were less likely to be reconstructed regardless of their BMI and comorbidities. Larger breasted women may be considered worse prosthetic reconstruction candidates due to increased complications and suboptimal aesthetic outcomes but may find the increased invasiveness and recovery of autologous reconstruction an unattractive alternative. Furthermore, it is possible that surgeons may be less supportive of breast reconstruction for larger breasted women if there are concerns about safety or the aesthetic quality of the result. In the future, qualitative research must be done to determine why more larger breasted women choose not to be reconstructed as well as develop better ways to increase their reconstructive options.
许多研究致力于探讨女性在乳房切除术后选择不进行重建的原因。乳房大小的影响尚未得到充分研究。作者旨在评估乳房大小与重建选择之间的关系。对2011年至2014年间接受乳房切除术的女性进行了单中心回顾性研究。使用t检验、曼-惠特尼U检验和卡方检验分析人口统计学、手术变量和重建决策。显著（P <.05）变量被纳入多变量逻辑回归模型。共分析了约610例患者。乳房切除标本的中位重量为572克（62 - 5230克），与BMI无关（P =.44）。接受重建的女性乳房切除标本较轻，平均为643克，而未重建的为848克（P <.0001）。构建了一个控制种族、保险状况、合并症数量、乳房切除时年龄、癌症分期、BMI、标本重量和乳房切除侧别的回归模型。较低的标本重量（P =.005）、较低的癌症分期（P =.008）、双侧乳房切除（P =.042）和乳房切除时较年轻的年龄（P <.0001）与重建显著相关。无论BMI和合并症如何，乳房较大的女性进行重建的可能性较小。乳房较大的女性可能由于并发症增加和美学效果欠佳而被认为是假体重建较差的候选者，但可能会觉得自体重建增加的侵入性和恢复过程缺乏吸引力。此外，如果担心安全或结果的美学质量，外科医生可能对乳房较大的女性进行乳房重建的支持较少。未来，必须进行定性研究，以确定为什么更多乳房较大的女性选择不进行重建，并开发更好的方法来增加她们的重建选择。
