Philadelphia, Pa.
From the Division of Plastic Surgery, University of Pennsylvania.
Plast Reconstr Surg. 2018 Mar;141(3):550-565. doi: 10.1097/PRS.0000000000004108.
An untoward outcome following breast reconstruction is diminished or complete loss of sensation. As the reconstructive paradigm continues to evolve, sensory restoration following reconstruction remains a research focus. Despite the multitude of published outcomes, there is marked heterogeneity across studies, thus confounding published outcomes. This study critically appraises the literature to summarize outcomes and establish a framework to guide clinical practice and future research.
A literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in an effort to perform a meta-analysis. The Ovid MEDLINE, PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov online databases were queried to capture all publications between 1990 and 2017 that investigated postreconstruction breast sensation. The primary outcome of interest was breast sensation following both implant-based and autologous reconstruction with or without neurotization. Secondary outcomes of interest included time to sensory testing and patient-reported outcomes.
Overall, 503 titles were screened, from which 37 articles were ultimately included for analysis, accounting for 1299 patients. There was major methodologic variability and inconsistent measurable outcomes across studies. It can be deduced that postoperative sensation returns spontaneously and unpredictably, neurotization enhances the magnitude and rapidity of sensory restoration when compared to nonneurotized reconstruction, and a sensate reconstruction improves patient-reported outcomes.
Significant study design discrepancies exist, making it difficult to combine data and assess results. To effectively study breast sensation and the impact of neurotization, future investigation will depend on standardizing the way in which breast sensation is measured.
乳房重建后出现不良后果是感觉减退或完全丧失。随着重建模式的不断发展，重建后的感觉恢复仍然是研究的重点。尽管有大量的已发表的结果，但研究之间存在明显的异质性，从而混淆了已发表的结果。本研究批判性地评估文献，总结结果，并建立一个框架来指导临床实践和未来的研究。
根据系统评价和荟萃分析的首选报告项目指南进行文献回顾，以进行荟萃分析。在 Ovid MEDLINE、PubMed、Embase、Scopus、Cochrane 和 ClinicalTrials.gov 在线数据库中查询所有 1990 年至 2017 年期间调查重建后乳房感觉的出版物。主要研究结果是在有或没有神经化的情况下，基于植入物和自体重建后的乳房感觉。次要研究结果包括感觉测试和患者报告结果的时间。
共筛选了 503 个标题，其中 37 个最终被纳入分析，共涉及 1299 例患者。研究之间存在重大的方法学差异和不一致的可测量结果。可以推断，术后感觉会自发且不可预测地恢复，与非神经化重建相比，神经化会增强感觉恢复的程度和速度，感觉重建会改善患者的报告结果。
存在显著的研究设计差异，难以合并数据和评估结果。为了有效地研究乳房感觉和神经化的影响，未来的研究将取决于标准化乳房感觉的测量方式。
