Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.
J Plast Reconstr Aesthet Surg. 2020 Feb;73(2):278-285. doi: 10.1016/j.bjps.2019.09.040. Epub 2019 Oct 2.
Breast reconstruction following mastectomy can increase the quality of life of patients. Reconstruction methods can broadly be divided into implant-based and autologous tissue reconstruction. Patient-reported outcomes following breast reconstruction are one of the most important success parameters. In this systematic review and meta-analysis, we aimed to compare the two methods using the recognized Breast-Q questionnaire.
We performed a systematic search in PubMed and EMBASE databases. Meta-analysis was performed on the five most commonly reported Breast-Q modules. RevMan 5.3 was used for statistical analysis. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies.
The search strategy resulted in 219 studies of which nine studies were included in the analysis, yielding 2129 implant-based and 825 autologous breast reconstructions. Overall satisfaction with outcome as well as breast was significantly higher among patients with autologous breast reconstructions (mean Breast-Q difference between the two groups was 9.82 [3.09, 16.54], p = 0.004, and 10.33 [95% CI 5.93, 14.74], p<0.00001, respectively). Sexual and psychosocial well-being was higher among autologous breast reconstructions. There was no difference in the physical well-being.
This is the first systematic review and meta-analysis to compare patient-reported outcomes of implant-based and autologous breast reconstruction. We found that autologous reconstruction yields a higher satisfaction with overall outcome and breast. These findings can aid clinicians when discussing breast reconstruction options with patients.
乳房切除术（mastectomy）后的乳房重建可以提高患者的生活质量。重建方法大致可分为基于植入物和自体组织的重建。乳房重建后的患者报告结局（patient-reported outcomes）是最重要的成功参数之一。在这项系统评价和荟萃分析中，我们旨在使用公认的 Breast-Q 问卷比较这两种方法。
我们在 PubMed 和 EMBASE 数据库中进行了系统搜索。对 Breast-Q 问卷中报告最多的五个模块进行了荟萃分析。使用 RevMan 5.3 进行统计分析。使用纽卡斯尔-渥太华质量评估表（Newcastle-Ottawa Quality Assessment Form）评估纳入研究的方法学质量。
搜索策略产生了 219 项研究，其中 9 项研究纳入了分析，共纳入了 2129 例基于植入物的乳房重建和 825 例自体乳房重建。自体乳房重建患者的总体结局满意度以及乳房满意度明显更高（两组之间的 Breast-Q 差异平均值为 9.82[3.09, 16.54]，p=0.004，和 10.33[95%CI 5.93, 14.74]，p<0.00001）。自体乳房重建患者的性和心理社会幸福感更高。身体幸福感无差异。
这是第一项比较基于植入物和自体乳房重建的患者报告结局的系统评价和荟萃分析。我们发现自体重建在总体结局和乳房满意度方面更高。这些发现可以帮助临床医生在与患者讨论乳房重建选择时提供参考。
