From the Department of Surgery, Duke University School of Medicine; and Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Department of Surgery, Emory University School of Medicine.
Plast Reconstr Surg. 2022 Mar 1;149(3):568-577. doi: 10.1097/PRS.0000000000008825.
Psychological factors are broadly understood to contribute to overall health, but their contribution to wound healing is less well defined. Limited data exist on the association of preoperative psychological factors such as body image and postoperative complications. The present study analyzed the association between preoperative body image factors and postoperative complications following breast reconstruction.
This was a prospective cohort study of 302 breast cancer patients undergoing breast reconstruction from 2011 to 2015. All patients completed the BREAST-Q; demographics, surgical details, and postoperative complications were recorded. The association of body image factors by means of the BREAST-Q and postoperative complications was analyzed.
On univariate analysis, patients who reported lower preoperative satisfaction with how they appeared in the mirror unclothed, or felt less self-confident or attractive, were significantly more likely to develop an infection postoperatively. Preoperative satisfaction scores were not associated with complications when analyzed in a multivariate fashion. On binomial logistic regression analysis, after controlling for age, body mass index, reconstruction technique, and use of radiotherapy, patients who reported less preoperative satisfaction with how comfortably bras fit or how they appeared in a mirror unclothed were at an increased risk for delayed wound healing.
Patients with lower preoperative body satisfaction were found to have an increased incidence of infections and delayed wound healing. Although postoperative outcomes are multifactorial, the data suggest that baseline psychological factors such as body image may play a role in postoperative outcomes. Broader use of prehabilitative therapies, targeted at psychosocial factors, may warrant further investigation to optimize postoperative outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
心理因素被广泛认为对整体健康有贡献，但它们对伤口愈合的贡献却不那么明确。关于术前心理因素（如身体形象）与术后并发症之间的关联，现有数据有限。本研究分析了术前身体形象因素与乳房重建术后并发症之间的关系。
这是一项前瞻性队列研究，纳入了 2011 年至 2015 年间接受乳房重建的 302 例乳腺癌患者。所有患者均完成了 BREAST-Q 量表评估；记录了人口统计学、手术细节和术后并发症。分析了 BREAST-Q 量表中的身体形象因素与术后并发症之间的关联。
单因素分析显示，术前对不穿衣时镜子中的自己外观、自信心或吸引力评价较低的患者，术后发生感染的风险显著增加。当以多变量方式分析时，术前满意度评分与并发症无关。在二项逻辑回归分析中，在校正年龄、体重指数、重建技术和放疗使用后，报告术前对胸罩的舒适度或不穿衣时镜子中的外观满意度较低的患者，延迟伤口愈合的风险增加。
发现术前身体满意度较低的患者感染和延迟伤口愈合的发生率增加。尽管术后结局是多因素的，但数据表明，基线心理因素（如身体形象）可能在术后结局中发挥作用。更广泛地应用以心理社会因素为目标的康复前治疗可能需要进一步研究，以优化术后结局。
临床问题/证据水平：风险，III 级。
