Shien Tadahiko, Nogi Hiroko, Ogiya Akiko, Ishitobi Makoto, Yamauchi Chikako, Shimo Ayaka, Narui Kazutaka, Nagura Naomi, Seki Hirohito, Terata Kaori, Saiga Miho, Uchida Tatsuya, Sasada Shinsuke, Sakurai Teruhisa, Niikura Naoki, Mori Hiroki
Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 7008558, Japan.
Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Breast Cancer. 2025 May 26. doi: 10.1007/s12282-025-01723-5.
Immediate breast reconstruction (IBR) has become increasingly recognized in Japan as an important component of breast cancer care, improving patients' quality of life after mastectomy. While the adoption of IBR is growing, the reconstruction rate in Japan remains lower than in Western countries. To clarify the current practice and challenges, the Japanese Breast Cancer Society (JBCS) conducted a nationwide survey.
We conducted a comprehensive web-based questionnaire survey among all JBCS-certified institutions between December 2020 and February 2021. The survey assessed institutional capabilities, surgical techniques, decision-making criteria for BR, and the integration of adjuvant therapy.
A total of 429 institutions responded, with 72.5% offering BR and 61.7% capable of providing immediate reconstruction. Nipple-sparing mastectomy (NSM) was performed at 73.7% of institutions offering reconstruction. Multidisciplinary conferences with plastic surgeons were held at 70.5% of institutions. Approximately 30% of institutions discontinued IBR if sentinel lymph node metastases were detected intraoperatively, and 62.8% avoided recommending IBR for patients likely to require postoperative radiation therapy. In 94% of institutions, BR did not cause delays in the administration of adjuvant chemotherapy. However, 15% of institutions modified their radiation therapy approach in reconstructed patients. Additionally, 27% of physicians still believed that BR could negatively affect prognosis.
The survey confirmed that IBR is widely performed and feasible in Japan. However, institutional differences, limited access to plastic surgeons, and persistent misconceptions remain significant barriers. Strengthening multidisciplinary collaboration and establishing standardized guidelines will help improve BR rates and patient outcomes in Japan.
即刻乳房重建（IBR）在日本已日益被视为乳腺癌治疗的重要组成部分，可提高乳房切除术后患者的生活质量。尽管IBR的应用在不断增加，但日本的重建率仍低于西方国家。为了阐明当前的实践情况和挑战，日本乳腺癌协会（JBCS）开展了一项全国性调查。
我们在2020年12月至2021年2月期间，对所有获得JBCS认证的机构进行了全面的基于网络的问卷调查。该调查评估了机构能力、手术技术、乳房重建的决策标准以及辅助治疗的整合情况。
共有429家机构做出回应，其中72.5%提供乳房重建服务，61.7%能够进行即刻重建。在提供重建服务的机构中，73.7%进行了保留乳头的乳房切除术（NSM）。70.5%的机构与整形外科医生举行了多学科会议。如果术中检测到前哨淋巴结转移，约30%的机构会停止IBR，62.8%的机构避免为可能需要术后放疗的患者推荐IBR。在94%的机构中，乳房重建并未导致辅助化疗的延迟。然而，15%的机构对重建患者调整了放疗方案。此外，27%的医生仍然认为乳房重建可能对预后产生负面影响。
该调查证实，IBR在日本广泛开展且可行。然而，机构差异、整形外科医生资源有限以及持续存在的误解仍然是重大障碍。加强多学科合作并制定标准化指南将有助于提高日本的乳房重建率和患者治疗效果。
