比较接受延迟性乳房重建的放疗患者的患者报告目标和核心结局与 Latissimus dorsi 带假体和 DIEP 的差异。

Comparison of patient-reported achievements of goals and core outcomes with delayed breast reconstruction in irradiated patients: latissimus dorsi with an implant versus DIEP.

机构信息

Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden; Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.

出版信息

J Plast Surg Hand Surg. 2023 Aug 24;58:74-81. doi: 10.2340/jphs.v58.12417.

DOI:10.2340/jphs.v58.12417

PMID:37615328

Abstract

BACKGROUND

Different women's individual goals with a breast reconstruction vary, and few studies compare techniques in light of the different goals. This study aimed to compare patient-reported core outcomes in patients reconstructed with deep inferior epigastric artery perforator (DIEP) flaps and latissimus dorsi (LD) flaps. Second, breast-related factors that the patients were particularly satisfied/dissatisfied with were analyzed.

METHODS

This was a retrospective cross-sectional study, which includes women who had undergone mastectomy and radiation, followed by delayed breast reconstructions with either LD flap and implant or DIEP flap during 2007-2017. The patient-reported core outcomes of overall breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being were analyzed using BREAST-Q.

RESULTS

The patients were divided into LD and implant (n = 135 patients) and DIEP (n = 118 patients) groups, and both were demographically similar. The median follow-up was 8 years. The DIEP group scored significantly higher than the LD and implant group in five out of six domains. A high satisfaction was reported in questions regarding the feeling or appearance when having clothes on, whereas the greatest dissatisfaction was reported regarding questions entailing symmetry and the appearance without clothes.

CONCLUSION

After 7 years, patients' breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being seem to be higher in irradiated patients who have been reconstructed with DIEP flap as compared to patients reconstructed with LD flap and implant. In both groups, patient satisfaction is high regarding their appearance when clothed, whereas the lowest satisfaction scores were reported in situations without clothing.

摘要

背景

不同女性的乳房重建个体目标各不相同，鲜有研究针对不同目标对技术进行比较。本研究旨在比较接受腹壁下动脉穿支皮瓣（DIEP）和背阔肌皮瓣（LD）重建的患者的患者报告的核心结局，并分析患者特别满意/不满意的乳房相关因素。

方法

这是一项回顾性的横断面研究，纳入了 2007 年至 2017 年间接受过乳房切除术和放疗，随后接受 LD 皮瓣和植入物或 DIEP 皮瓣延迟乳房重建的女性。使用 BREAST-Q 分析了整体乳房特异性生活质量、正常感、女性美容满意度、自尊、情绪健康和身体健康等患者报告的核心结局。

结果

患者分为 LD 和植入物（n=135 例）和 DIEP（n=118 例）组，两组在人口统计学方面相似。中位随访时间为 8 年。DIEP 组在六个领域中的五个领域的评分明显高于 LD 和植入物组。在穿衣时的感觉或外观方面，报告的满意度较高，而在涉及对称性和不穿衣时的外观的问题方面，报告的不满意程度最高。