Ochoa Oscar, Garza Ramon, Pisano Steven, Chrysopoulo Minas, Ledoux Peter, Arishita Gary, Ketchum Norma, Michalek Joel E, Nastala Chet
From Plastic Reconstructive and Microsurgical Associates; and University of Texas Health.
Plast Reconstr Surg. 2022 May 1;149(5):848e-857e. doi: 10.1097/PRS.0000000000009044. Epub 2022 Mar 2.
Without reconstruction, mastectomy alone can produce significant detrimental effects on health-related quality of life. The magnitude of quality-of-life benefits following breast reconstruction may be unique based on timing of reconstruction. Facilitated by the BREAST-Q questionnaire, characterization of how reconstruction timing differentially affects patient-reported quality of life is essential for improved evidence-based clinical practice.
Consecutive DIEP flap breast reconstruction patients prospectively completed BREAST-Q questionnaires preoperatively and at two different time intervals postoperatively. The first (postoperative time point A) and second (postoperative time point B) postoperative questionnaires were completed 1 month postoperatively and following breast revision/symmetry procedures, respectively. Postoperative flap and donor-site complications were recorded prospectively. Stratified by timing (immediate versus delayed) of reconstruction, preoperative clinical data, operative morbidity, and BREAST-Q scores were compared at all time points.
Between July of 2012 and August of 2016, 73 patients underwent 130 DIEP flap breast reconstructions. Collectively, breast satisfaction, psychosocial well-being, and sexual well-being scores significantly (p < 0.001) increased postoperatively versus baseline. Chest and abdominal physical well-being scores returned to baseline levels by postoperative time point B. Preoperatively, patients undergoing delayed breast reconstruction reported significantly (p < 0.05) lower breast satisfaction, psychosocial well-being, and sexual well-being scores compared to immediate reconstruction patients. Postoperatively, delayed and immediate reconstruction patients reported similar quality-of-life scores. Outcome satisfaction and flap and donor-site morbidity were similar between groups irrespective of timing of reconstruction.
In this prospective study, patient-reported outcomes demonstrate significant improvements in breast satisfaction, psychosocial well-being, and sexual well-being among patients following DIEP flap reconstruction. Moreover, preoperative differences in quality-of-life scores among delayed/immediate reconstruction patients were eliminated postoperatively.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
若不进行重建，单纯乳房切除术会对健康相关生活质量产生显著的不利影响。乳房重建术后生活质量改善的程度可能因重建时机而异。在BREAST-Q问卷的辅助下，明确重建时机如何不同程度地影响患者报告的生活质量，对于改进循证临床实践至关重要。
连续的腹壁下动脉穿支（DIEP）皮瓣乳房重建患者在术前以及术后两个不同时间间隔前瞻性地完成BREAST-Q问卷。术后第一份（术后时间点A）和第二份（术后时间点B）问卷分别在术后1个月以及乳房修复/对称手术之后完成。前瞻性记录术后皮瓣和供区并发症。根据重建时机（即刻与延迟）分层，比较所有时间点的术前临床数据、手术发病率和BREAST-Q评分。
2012年7月至2016年8月期间，73例患者接受了130次DIEP皮瓣乳房重建术。总体而言，与基线相比，术后乳房满意度、心理社会幸福感和性幸福感评分显著提高（p < 0.001）。胸部和腹部身体幸福感评分在术后时间点B时恢复到基线水平。术前，与即刻重建患者相比，接受延迟乳房重建的患者报告的乳房满意度、心理社会幸福感和性幸福感评分显著更低（p < 0.05）。术后，延迟和即刻重建患者报告的生活质量评分相似。无论重建时机如何，两组之间的结果满意度以及皮瓣和供区发病率相似。
在这项前瞻性研究中，患者报告的结果表明，腹壁下动脉穿支皮瓣重建术后患者的乳房满意度、心理社会幸福感和性幸福感有显著改善。此外，延迟/即刻重建患者术前生活质量评分的差异在术后消除。
临床问题/证据级别：治疗性，II级
