Karunanayake Mihiran, Bortoluzzi Patricia, Chollet André, Lin Jenny C
Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Québec, Canada.
Plast Surg (Oakv). 2017 Nov;25(4):242-248. doi: 10.1177/2292550317728034. Epub 2017 Sep 20.
Post-mastectomy breast reconstruction (PMBR) improves psychosocial well-being, quality of life, and body image. Reconstruction rates vary widely (up to 42% in the United States), but the few Canadian studies available report rates of 3.8% to 7.9%. We sought to evaluate the current state of breast reconstruction in 1 Canadian teaching hospital and factors determining patients' access to reconstruction.
We performed a retrospective chart review of all patients with breast cancer undergoing mastectomy alone or mastectomy and reconstruction at a Canadian hospital between 2010 and 2013. We calculated rates of breast reconstruction and compared patient characteristics between the 2 groups, and then performed a multiple logistic regression to determine factors increasing the odds of receiving breast reconstruction.
A total of 152 patients underwent 154 total or modified radical mastectomies. We obtained a rate of PMBR of 21%, 14% immediate reconstruction, and 8% delayed. Statistical analysis showed that compared to patients with mastectomy alone, patients who received PMBR were significantly younger, with a larger percentage having bilateral mastectomies, non-invasive breast cancer, and residing further from the hospital. Patients less than 50 years old and those with bilateral mastectomies had significantly greater odds of having a reconstruction.
Our Canadian tertiary care institution has a high volume of breast surgery and an active breast reconstruction team. However, the rate of immediate reconstruction remains low compared to similar centers in the United States. We recommend a united effort to increase awareness regarding PMBR and address common misconceptions hindering patients' access to breast reconstruction.
Epidemiologic study, Level III.
乳房切除术后乳房重建（PMBR）可改善心理社会幸福感、生活质量和身体形象。重建率差异很大（在美国高达42%），但现有的少数加拿大研究报告的重建率为3.8%至7.9%。我们试图评估加拿大一家教学医院乳房重建的现状以及决定患者获得重建机会的因素。
我们对2010年至2013年期间在加拿大一家医院接受单纯乳房切除术或乳房切除术及重建的所有乳腺癌患者进行了回顾性病历审查。我们计算了乳房重建率，并比较了两组患者的特征，然后进行多因素逻辑回归分析以确定增加接受乳房重建几率的因素。
共有152例患者接受了154次全乳或改良根治性乳房切除术。我们得出的PMBR率为21%，即刻重建率为14%，延迟重建率为8%。统计分析表明，与单纯接受乳房切除术的患者相比，接受PMBR的患者明显更年轻，双侧乳房切除术、非浸润性乳腺癌患者的比例更高，且居住距离医院更远。年龄小于50岁的患者和接受双侧乳房切除术的患者进行重建的几率明显更高。
我们这家加拿大三级医疗机构进行大量的乳房手术，并有一个活跃的乳房重建团队。然而，与美国的类似中心相比，即刻重建率仍然较低。我们建议共同努力提高对PMBR的认识，并消除阻碍患者获得乳房重建的常见误解。
流行病学研究，三级。
