Everaars Kristel E, de Laat Erik H, Young-Afat Danny A, Tjin Esther P M, Ulrich Dietmar J O
Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB, Nijmegen, The Netherlands.
Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands.
Aesthetic Plast Surg. 2025 Feb;49(3):733-740. doi: 10.1007/s00266-024-04272-y. Epub 2024 Sep 3.
Although deep inferior epigastric perforator (DIEP) flap breast reconstruction is the most widely used technique for autologous breast reconstruction, this technique leads to large scars in visible areas on breast and abdomen. So far, limited studies have thoroughly addressed the impact of breast and abdominal scars on satisfaction and Health-related Quality of Life (HR-QoL).
This research aimed to determine whether women with no/minor scar symptoms after undergoing DIEP-flap breast reconstruction differ in satisfaction and perceived HR-QoL from women with symptomatic scars.
In this cross-sectional survey study, women who had previously undergone DIEP-flap breast reconstruction completed an online survey. Patient-reported scar quality was assessed with the Patient and Observer Scar Assessment Scale (POSAS), and satisfaction and HR-QoL with BREAST-Q. Independent-samples t-tests were conducted to compare BREAST-Q scores between women with no/minor scar symptoms (POSAS overall opinion score 1-3) and women with symptomatic scars (POSAS overall opinion score 4-10).
A total of 248 women completed the survey. Women with scar symptoms had significantly worse BREAST-Q scores on 'Satisfaction with breasts,' 'Physical well-being,' 'Psychosocial well-being' and, 'Sexual well-being' compared to women with no/minor scar symptoms (p ≤ 0.001).
After DIEP-flap breast reconstructions, women with symptomatic breast and abdominal scars had a clinically relevant and statistically significant lower degree of satisfaction and HR-QoL compared to women who had no/minor scar symptoms. We therefore recommend to explicitly and repeatedly address inevitability of visible scars after DIEP-flap breast reconstruction, aiming to improve preoperative patient selection and post-operative expectation management.
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尽管腹壁下深动脉穿支（DIEP）皮瓣乳房重建术是自体乳房重建中应用最广泛的技术，但该技术会在乳房和腹部的可见部位留下较大疤痕。到目前为止，仅有有限的研究全面探讨了乳房和腹部疤痕对满意度及健康相关生活质量（HR-QoL）的影响。
本研究旨在确定接受DIEP皮瓣乳房重建术后无/轻微疤痕症状的女性与有症状性疤痕的女性在满意度和感知HR-QoL方面是否存在差异。
在这项横断面调查研究中，曾接受DIEP皮瓣乳房重建术的女性完成了一项在线调查。采用患者和观察者疤痕评估量表（POSAS）评估患者报告的疤痕质量，采用BREAST-Q评估满意度和HR-QoL。进行独立样本t检验，以比较无/轻微疤痕症状的女性（POSAS总体评价得分1-3）和有症状性疤痕的女性（POSAS总体评价得分4-10）之间的BREAST-Q得分。
共有248名女性完成了调查。与无/轻微疤痕症状的女性相比，有疤痕症状的女性在“乳房满意度”“身体幸福感”“心理社会幸福感”和“性幸福感”方面的BREAST-Q得分明显更差（p≤0.001）。
DIEP皮瓣乳房重建术后，有症状性乳房和腹部疤痕的女性与无/轻微疤痕症状的女性相比，在临床相关性和统计学意义上的满意度和HR-QoL较低。因此，我们建议明确且反复地告知患者DIEP皮瓣乳房重建术后可见疤痕的不可避免性，旨在改善术前患者选择和术后期望管理。
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