Stern Carrie S, Kim Minji, Smith Montes Elizabeth, Boe Lillian A, Zhang Kevin, Vingan Perri, Carter Jeanne, Mehrara Babak J, Tadros Audree B, Allen Robert J, Nelson Jonas A
From the Plastic and Reconstructive Surgery Service.
Department of Epidemiology and Biostatistics.
Plast Reconstr Surg. 2025 Mar 1;155(3):407-420. doi: 10.1097/PRS.0000000000011657. Epub 2024 Jul 23.
Up to 85% of patients with breast cancer report sexual health concerns, but their concerns are not adequately addressed by providers. Sexual dysfunction among patients with breast cancer remains understudied. The authors aimed to investigate the impact of breast-conserving therapy (BCT) and postmastectomy breast reconstruction (PMBR) on the sexual health of patients with breast cancer and the frequency of sexual medicine consultation in postoperative care.
The authors conducted a retrospective analysis of patients who underwent BCT or PMBR and completed the Sexual Well-Being section of the BREAST-Q BCT and Reconstruction modules from January of 2010 through October of 2022. They compared Sexual Well-Being scores between patients who received BCT or PMBR over time up to 5 years after surgery, delineated associated demographic and clinical factors with Sexual Well-Being scores, and evaluated the frequency of sexual medicine consultations.
Of 15,857 patients, 8510 (53.7%) underwent BCT and 7347 (46.3%) underwent PMBR. Patients who underwent PMBR had significantly lower Sexual Well-Being scores than patients who underwent BCT from preoperatively to 5 years postoperatively. Regression analyses showed that patients who underwent PMBR scored 7.6 points lower at 1 year than patients who underwent BCT. Separated marital status, higher body mass index, cardiovascular disease, hyperlipidemia, psychiatric diagnosis, and neoadjuvant chemotherapy were associated with significantly lower Sexual Well-Being scores. A total of 299 patients (3.5%) who underwent BCT and 400 patients (5.4%) who underwent PMBR received sexual medicine consultations.
Sexual health concerns must be considered in breast cancer care, particularly among patients who undergo PMBR. Although many patients experience sexual dysfunction, most do not receive a sexual medicine consultation, suggesting an opportunity for providers to improve the sexual health of patients with breast cancer.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
高达85%的乳腺癌患者报告有性健康方面的担忧，但医疗服务提供者并未充分解决他们的担忧。乳腺癌患者的性功能障碍仍未得到充分研究。作者旨在调查保乳治疗（BCT）和乳房切除术后乳房重建（PMBR）对乳腺癌患者性健康的影响以及术后护理中性医学咨询的频率。
作者对2010年1月至2022年10月期间接受BCT或PMBR并完成BREAST-Q BCT和重建模块中性健康部分的患者进行了回顾性分析。他们比较了接受BCT或PMBR的患者术后长达5年的性健康评分，确定与性健康评分相关的人口统计学和临床因素，并评估性医学咨询的频率。
在15857名患者中，8510名（53.7%）接受了BCT，7347名（46.3%）接受了PMBR。从术前到术后5年，接受PMBR的患者的性健康评分明显低于接受BCT的患者。回归分析显示，接受PMBR的患者在1年时的评分比接受BCT的患者低7.6分。分居的婚姻状况、较高的体重指数、心血管疾病、高脂血症、精神疾病诊断和新辅助化疗与明显较低的性健康评分相关。共有299名（3.5%）接受BCT的患者和400名（5.4%）接受PMBR的患者接受了性医学咨询。
在乳腺癌护理中必须考虑性健康问题，尤其是在接受PMBR的患者中。尽管许多患者存在性功能障碍，但大多数患者没有接受性医学咨询，这表明医疗服务提供者有机会改善乳腺癌患者的性健康。
临床问题/证据水平：治疗性，III级。
