From Plastic Reconstructive & Microsurgical Associates; and the University of Texas Health Science Center at San Antonio.
Plast Reconstr Surg. 2019 Jun;143(6):1589-1600. doi: 10.1097/PRS.0000000000005616.
Breast reconstruction plays a significant role in breast cancer treatment recovery. Introduction of the BREAST-Q questionnaire has facilitated quantifying patient-reported quality-of-life measures, promoting improved evidence-based clinical practice. Information regarding the effects of body mass index on patient-reported outcomes and health-related quality of life is significantly lacking.
Consecutive deep inferior epigastric perforator (DIEP) flap breast reconstruction patients prospectively completed BREAST-Q questionnaires preoperatively and at two points postoperatively. The first (postoperative time point A) and second (postoperative time point B) postoperative questionnaires were completed 1 month postoperatively and following breast revision, respectively. Postoperative flap and donor-site complications were recorded prospectively. BREAST-Q scores were compared at all time points and stratified by body mass index group (≤25, >25 to 29.9, 30 to 34.9, and ≥35 kg/m).
Between July of 2012 and August of 2016, 73 patients underwent 130 DIEP flap breast reconstructions. Breast satisfaction and psychosocial and sexual well-being scores increased significantly postoperatively. Chest and abdominal physical well-being scores returned to baseline levels by postoperative point B. Preoperatively, stratified by body mass index, breast satisfaction and psychosocial well-being scores were significantly lower among patients with body mass index of 35 or higher and of more than 30, respectively. After reconstruction, not only were breast satisfaction, psychosocial, and sexual well-being scores significantly improved in all body mass index groups versus baseline, but also between-body mass index group differences were no longer present. Outcome satisfaction, flap, and donor-site morbidity were similar irrespective of body mass index.
Patient-reported outcomes demonstrate significant improvements in breast satisfaction and psychosocial and sexual well-being among patients following DIEP flap reconstruction. Preoperative differences in quality-of-life scores were improved in patients with obesity (body mass index ≥30 kg/m).
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
乳房重建在乳腺癌治疗康复中起着重要作用。BREAST-Q 问卷的引入促进了患者报告的生活质量测量的量化，从而促进了基于证据的临床实践的改进。关于身体质量指数对患者报告的结果和健康相关生活质量的影响的信息非常缺乏。
连续的腹壁下动脉穿支（DIEP）皮瓣乳房重建患者前瞻性地在术前和术后两点完成 BREAST-Q 问卷。第一次（术后时间点 A）和第二次（术后时间点 B）术后问卷分别在术后 1 个月和乳房修复后完成。前瞻性地记录术后皮瓣和供区并发症。在所有时间点比较 BREAST-Q 评分，并按身体质量指数组（≤25、>25 至 29.9、30 至 34.9 和≥35 kg/m）进行分层。
2012 年 7 月至 2016 年 8 月期间，73 例患者行 130 例 DIEP 皮瓣乳房重建术。乳房满意度和心理社会及性健康评分在术后显著增加。胸部和腹部身体舒适度评分在术后 B 点恢复到基线水平。术前，按身体质量指数分层，身体质量指数为 35 或更高和 30 或更高的患者乳房满意度和心理社会健康评分显著较低。重建后，不仅所有身体质量指数组的乳房满意度、心理社会和性健康评分均较基线显著改善，而且不同身体质量指数组之间的差异不再存在。无论身体质量指数如何，术后满意度、皮瓣和供区发病率均相似。
患者报告的结果表明，DIEP 皮瓣重建后患者的乳房满意度以及心理社会和性健康均有显著改善。肥胖患者（身体质量指数≥30 kg/m）的生活质量评分术前差异得到改善。
临床问题/证据水平：风险，II 级。
