Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Ann Surg. 2019 Sep;270(3):473-483. doi: 10.1097/SLA.0000000000003467.
To better understand the long-term patient-reported outcomes (PROs) in satisfaction and health-related quality of life (QOL) following post-mastectomy reconstruction (PMR) using the BREAST-Q, comparing PROs from patients undergoing implant-based breast reconstruction (IBR) or autologous breast reconstruction (ABR).
Multiple studies have demonstrated growth in mastectomy rates and concurrent increase in PMR utilization. However, most studies examining PMR PROs focus on short postoperative time periods-mainly within 2 years.
BREAST-Q scores from IBR or ABR patients at a tertiary center were prospectively collected from 2009 to 2017. Mean scores and standard deviations (SDs) were calculated for satisfaction with breast, satisfaction with outcome, psychosocial well-being, physical well-being of the chest, and sexual well-being. Satisfaction with breasts and physical well-being of the chest were compared using regression models at postoperative years 1, 3, 5, and 7.
Overall, 3268 patients were included, with 336 undergoing ABR and 2932 undergoing IBR. Regression analysis demonstrated that ABR patients had greater postoperative satisfaction with breast scores at all timepoints compared with IBR patients. Postoperative radiation and mental illness adversely impacted satisfaction with breast scores. Furthermore, mental illness impacted physical wellbeing of the chest at all timepoints. IBR patients had satisfaction scores that remained stable over the study period.
This study presents the largest prospective examination of PROs in PMR to date. Patients who opted for ABR had significantly higher satisfaction with their breast and QOL at each assessed time point, but IBR patients had stable long-term satisfaction and QOL postoperatively.
通过使用 BREAST-Q 更好地了解乳房切除术后重建 (PMR) 后患者满意度和健康相关生活质量 (QOL) 的长期患者报告结局 (PRO)，比较接受基于植入物的乳房重建 (IBR) 或自体乳房重建 (ABR) 的患者的 PRO。
多项研究表明乳房切除术的比率不断增长，同时 PMR 的利用率也在增加。然而，大多数研究检查 PMR PRO 主要集中在术后短期时间段内 - 主要在 2 年内。
从 2009 年到 2017 年，在一家三级中心前瞻性地收集了 IBR 或 ABR 患者的 BREAST-Q 评分。计算了满意度、结果满意度、心理幸福感、胸部身体幸福感和性幸福感的平均值和标准差 (SD)。使用回归模型比较了术后 1、3、5 和 7 年的乳房满意度和胸部身体幸福感。
共有 3268 名患者入组，其中 336 名患者接受 ABR，2932 名患者接受 IBR。回归分析表明，与 IBR 患者相比，ABR 患者在所有时间点的乳房满意度都更高。术后放疗和精神疾病对乳房满意度评分有不利影响。此外，精神疾病在所有时间点都影响了胸部身体幸福感。IBR 患者的满意度评分在整个研究期间保持稳定。
这项研究是迄今为止对 PMR 中 PRO 的最大前瞻性检查。选择 ABR 的患者在每个评估时间点对乳房和 QOL 的满意度都显著更高，但 IBR 患者在术后具有稳定的长期满意度和 QOL。
