From the Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital; the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan Medical School; and the Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2019 Jun;143(6):1159e-1168e. doi: 10.1097/PRS.0000000000005602.
In choosing between implant-based and autologous breast reconstruction, surgeons and patients must weigh relative risks and benefits. However, differences in outcomes across procedure types may vary between unilateral versus bilateral reconstructions. Procedure-related differences in complications and patient-reported outcomes were evaluated for unilateral and bilateral reconstruction.
Complications and patient-reported outcomes (BREAST-Q and Patient-Reported Outcomes measurement Information System surveys) were assessed at 2 years for patients undergoing autologous or implant-based reconstructions. Stratified regression models compared outcomes between autologous and implant-based reconstructions, separately for unilateral and bilateral cohorts.
Among 2125 patients, 917 underwent unilateral (600 implant and 317 autologous) and 1208 underwent bilateral (994 implant and 214 autologous) reconstructions. Complication rates were significantly higher in the autologous versus implant-based group for both unilateral (overall: OR, 2.50, p < 0.001; major: OR, 2.19, p = 0.001) and bilateral (overall: OR, 2.13, p < 0.001; major: OR, 1.69, p = 0.014) cohorts. In unilateral reconstruction, the autologous group demonstrated significantly better patient-reported outcomes versus implant-based group in satisfaction with breast (mean difference, 9.85; p < 0.001), psychosocial well-being (mean difference, 4.84; p = 0.006), and sexual well-being (mean difference, 11.42; p < 0.001). In bilateral reconstruction, the autologous group demonstrated significantly higher patient-reported outcomes only for satisfaction with breast (mean difference, 5.13; p = 0.001).
Although autologous reconstruction is associated with significantly better patient-reported outcomes compared to implant-based techniques in unilateral reconstruction, procedure choice has far less impact in bilateral reconstruction. Autologous procedures have higher complications rates in both unilateral and bilateral settings.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在选择基于植入物和自体乳房重建时，外科医生和患者必须权衡相对风险和益处。然而，不同手术类型的结果差异可能在单侧与双侧重建之间有所不同。本研究评估了单侧和双侧重建中与手术相关的并发症和患者报告的结局差异。
对接受自体或植入物重建的患者在 2 年时进行并发症和患者报告的结局（BREAST-Q 和患者报告的结局测量信息系统调查）评估。分层回归模型分别比较了单侧和双侧队列中自体和植入物重建之间的结局。
在 2125 例患者中，917 例接受了单侧（600 例植入物和 317 例自体），1208 例接受了双侧（994 例植入物和 214 例自体）重建。与植入物组相比，自体组的单侧（总体：OR，2.50，p<0.001；主要：OR，2.19，p=0.001）和双侧（总体：OR，2.13，p<0.001；主要：OR，1.69，p=0.014）重建的并发症发生率均显著更高。在单侧重建中，自体组在乳房满意度（平均差异，9.85；p<0.001）、心理社会健康（平均差异，4.84；p=0.006）和性健康（平均差异，11.42；p<0.001）方面的患者报告结局明显优于植入物组。在双侧重建中，自体组仅在乳房满意度方面表现出明显更高的患者报告结局（平均差异，5.13；p=0.001）。
尽管与单侧重建中的植入物技术相比，自体重建与显著更好的患者报告结局相关，但手术选择在双侧重建中影响要小得多。在单侧和双侧重建中，自体手术的并发症发生率都更高。
临床问题/证据水平：治疗性，III 级。
