Riggio Egidio, Alfieri Sara, Toffoli Elisa, Borreani Claudia
Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Aesthetic Plast Surg. 2023 Feb;47(1):30-39. doi: 10.1007/s00266-022-03061-9. Epub 2022 Aug 26.
The literature that has explored differences between direct-to-implant (DTI) and expander-based (EB) breast reconstruction has mainly focused on complications, with results not always unambiguous. Moreover, there are limited data 1) comparing DTI and EB breast reconstruction after nipple-sparing mastectomy (NSM) and 2) from the patient's perspective.
The aim of this study was to compare satisfaction and well-being in patients undergoing DTI and EB reconstruction after NSM in a Comprehensive Cancer Center, exploring what factors can be related to satisfaction and well-being.
The study design is monocentric, observational and retrospective. The participants completed an online questionnaire containing the Breast-Q and some socio-demographic variables (year of birth, level of education, civil status). Clinical information was obtained from the institutional database. Surgical techniques in the two branches of NSM were similar: all skin incisions, lateral to the areola; all implants, subpectoral (EB: conventionally submuscular; DTI: dual-plane pocket); all without synthetic mesh or acellular tissue matrix.
A total of 120 patients (45% with EB and 55% with DTI) completed the questionnaire. We found that there are no differences between EB and DTI concerning the satisfaction and well-being of NSM patients, except for satisfaction with information, which is greater in the DTI group. In EB patients, no variables among those explored are related to satisfaction and well-being. In DTI patients, level of education is positive related to satisfaction with implants and physical well-being, Tumor-Node-Metastasis (TNM) and body mass index (BMI) are negative related to satisfaction with information and TNM also with satisfaction for plastic surgery.
EB and DTI do not differ in terms of patient well-being, but EB requires a more careful counselling by the surgeon.
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探讨直接植入式（DTI）和扩张器植入式（EB）乳房重建差异的文献主要集中在并发症方面，结果并不总是明确的。此外，比较保留乳头的乳房切除术（NSM）后DTI和EB乳房重建的数据有限，且从患者角度出发的数据也有限。
本研究旨在比较综合癌症中心接受NSM后进行DTI和EB重建患者的满意度和生活质量，探究哪些因素可能与满意度和生活质量相关。
本研究设计为单中心、观察性和回顾性研究。参与者完成一份包含乳房Q问卷和一些社会人口统计学变量（出生年份、教育程度、婚姻状况）的在线问卷。临床信息从机构数据库中获取。NSM两个分支的手术技术相似：所有皮肤切口均在乳晕外侧；所有植入物均置于胸大肌下（EB：传统的胸大肌下；DTI：双平面腔隙）；所有手术均不使用合成网片或无细胞组织基质。
共有120名患者（45%为EB组，55%为DTI组）完成了问卷。我们发现，除了对信息的满意度DTI组更高外，EB组和DTI组在NSM患者的满意度和生活质量方面没有差异。在EB组患者中，所探究的变量与满意度和生活质量均无关。在DTI组患者中，教育程度与对植入物的满意度和身体生活质量呈正相关，肿瘤-淋巴结-转移（TNM）分期和体重指数（BMI）与对信息的满意度呈负相关，TNM分期还与对整形手术的满意度呈负相关。
EB和DTI在患者生活质量方面没有差异，但EB需要外科医生进行更仔细的咨询。
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