Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:360-366. doi: 10.1016/j.bjps.2023.07.035. Epub 2023 Jul 21.
Although breast reconstruction in the setting of post-mastectomy radiotherapy (PMRT) is controversial, we offer nipple-sparing mastectomy and immediate implant-based breast reconstruction ([N]SSM/IIBR) to women needing primary mastectomy regardless of PMRT. Nevertheless, some of these women have no reconstruction.
To assess the uptake of breast reconstruction in women who undergo PMRT and the patient characteristics associated with such uptake. Additionally, we assessed the determinants of forgoing breast reconstruction.
Demographic, physical and oncological characteristics of women who underwent mastectomy, PMRT and breast reconstruction were compared to the characteristics of those who did not undergo breast reconstruction from 2013 through 2018. As determinants of delaying or refraining from breast reconstruction, we distinguished between an oncological reason, patient's preference, patient's co-morbidity, combined tobacco abuse and obesity and the need for PMRT.
490 women received PMRT. Of these, 396 women (81%) underwent combined [N]SSM/IIBR and PMRT or mastectomy and PMRT with delayed breast reconstruction. Ninety-four additional women (19%) did not undergo breast reconstruction. The latter group differed significantly from those who did in demographic and physical characteristics but not in terms of oncological diagnosis and history. Patient's preference was the single most frequent determinant of not performing either immediate or delayed breast reconstruction among these 94 women. Oncological status was not a major determinant in refraining from reconstruction.
The significant difference in non-oncological characteristics between the reconstructed and non-reconstructed women confirms the importance of these characteristics in the preference for either reconstruction or non-reconstruction.
尽管在接受乳房放疗（PMRT）后进行乳房重建存在争议，但我们为需要接受乳房切除术的女性提供保留乳头的乳房切除术和即刻假体乳房重建（NSSM/IIBR），而不论其是否接受 PMRT。尽管如此，仍有部分女性未进行重建。
评估接受 PMRT 的女性中乳房重建的接受情况，以及与接受该重建相关的患者特征。此外，我们评估了放弃乳房重建的决定因素。
比较了 2013 年至 2018 年间接受乳房切除术、PMRT 和乳房重建的女性与未接受乳房重建的女性的人口统计学、身体和肿瘤学特征。将肿瘤学原因、患者偏好、患者合并症、合并烟草滥用和肥胖以及 PMRT 需求作为延迟或放弃乳房重建的决定因素进行区分。
共有 490 名女性接受了 PMRT。其中，396 名女性（81%）接受了联合 NSSM/IIBR 和 PMRT 或乳房切除术和 PMRT 联合延迟乳房重建。另有 94 名女性（19%）未进行乳房重建。后者组在人口统计学和身体特征方面与前者存在显著差异，但在肿瘤学诊断和病史方面没有差异。在这 94 名女性中，患者的偏好是不进行即刻或延迟乳房重建的最常见决定因素。肿瘤学状况并不是放弃重建的主要决定因素。
重建组和未重建组在非肿瘤学特征方面存在显著差异，这证实了这些特征在患者对重建或非重建的偏好中的重要性。
