Meshulam-Derazon Sagit, Shay Tamir, Lewis Sivan, Adler Neta
Department of Plastic and Reconstructive Surgery, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Plastic and Reconstructive Surgery, Hebrew University-Hadassah Medical School, Jerusalem, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Isr Med Assoc J. 2018 Jun;20(6):340-344.
One-stage direct-to-implant post-mastectomy breast reconstruction has been gaining popularity over the traditional two-stage/tissue-expander approach.
To evaluate the outcome of the two post-mastectomy breast reconstruction procedures in terms of patient satisfaction.
Clinical data were collected by file review for patients who underwent mastectomy with immediate breast reconstruction at two tertiary medical centers in 2010-2013. Patients were asked to complete the BREAST-Q instrument, sent to them by post with a self-addressed, stamped, return envelope. Scores were compared by type of reconstruction performed.
Of the 92 patients who received the questionnaire, 59 responded: 39 had one-stage breast reconstruction and 20 underwent two-stage reconstruction. The two-stage reconstruction group was significantly older, had more background diseases, and were followed for a longer period. The one-stage reconstruction group had a higher proportion of BRCA mutation carriers. There was no significant between-group difference in postoperative complications. Mean BREAST-Q scores were similar in the two groups for all dimensions except satisfaction with information, which was higher in the patients after one-stage reconstruction. Women with more background diseases had better sexual well-being, and married women had better psychological well-being. Breast satisfaction was lower among patients treated with radiation and higher among patients with bilateral reconstruction; the latter subgroup also had higher physical well-being. Complications did not affect satisfaction.
Patients were equally satisfied with the outcome of one- and two-stage breast reconstruction. The choice of technique should be made on a case-by-case basis. Cost analyses are needed to construct a decision-making algorithm.
与传统的两阶段/组织扩张器方法相比，一期直接植入式乳房切除术后乳房重建越来越受欢迎。
从患者满意度方面评估两种乳房切除术后乳房重建手术的效果。
通过查阅病历收集2010 - 2013年在两家三级医疗中心接受乳房切除并立即进行乳房重建的患者的临床资料。要求患者填写BREAST-Q问卷，问卷通过邮寄方式发送给患者，并附上已写好地址、贴好邮票的回邮信封。根据所进行的重建类型比较得分。
在92名收到问卷的患者中，59人回复：39人进行了一期乳房重建，20人进行了两阶段重建。两阶段重建组患者年龄明显更大，有更多基础疾病，随访时间更长。一期重建组中携带BRCA突变的患者比例更高。两组术后并发症无显著差异。除了对信息的满意度外，两组在所有维度上的BREAST-Q平均得分相似，一期重建后的患者对信息的满意度更高。基础疾病较多的女性性健康状况更好，已婚女性心理健康状况更好。接受放疗的患者乳房满意度较低，双侧重建的患者乳房满意度较高；后一亚组的身体幸福感也更高。并发症不影响满意度。
患者对一期和两阶段乳房重建的效果同样满意。技术选择应根据具体情况而定。需要进行成本分析以构建决策算法。
