保留乳头的乳房切除术后即刻乳房重建中使用植入物和脂肪移植的美学和满意度的患者报告结局
Patient-Reported Outcomes of Aesthetics and Satisfaction in Immediate Breast Reconstruction After Nipple-Sparing Mastectomy With Implants and Fat Grafting.
作者信息
Qureshi Ali A, Odom Elizabeth B, Parikh Rajiv P, Myckatyn Terence M, Tenenbaum Marissa M
机构信息
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
出版信息
Aesthet Surg J. 2017 Oct 1;37(9):999-1008. doi: 10.1093/asj/sjx048.
BACKGROUND
Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective.
OBJECTIVES
To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes.
METHODS
This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively.
RESULTS
Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing.
CONCLUSIONS
Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM.
LEVEL OF EVIDENCE
背景
直接植入（DTI）和组织扩张器/植入物（TE/I）重建是保乳乳房切除术后（NSM）最常见的基于植入物的重建方式。然而，除了并发症发生率之外，比较这些选择的数据很少。脂肪移植已成为NSM重建中的一种辅助手段，以改善美学效果；然而，其对患者美学效果认知的影响仍不清楚。为了改善以患者为中心的护理，必须从患者的角度考虑美学效果。
目的
评估NSM术后接受即刻DTI与TE/I重建患者的美学满意度和生活质量的患者报告结局，并评估脂肪移植对这些结局的作用。
方法
这是一项前瞻性队列研究，比较接受DTI或TE/I重建的NSM患者。使用BREAST-Q评估患者报告结局。连续变量和分类变量分别使用t检验和Fisher精确检验进行分析。
结果
59例患者接受了113次重建，其中DTI（n = 41）或TE/I（n = 18）。平均随访时间为12.1个月。DTI和TE/I患者对结局的满意度相当，尽管TE/I患者最终植入物尺寸明显更大。接受脂肪移植的TE/I患者对结局和心理社会幸福感的满意度也明显更高。
结论
NSM术后DTI和TE/I重建的患者报告结局相当。为了使TE/I患者达到相似的满意度水平，与DTI患者相比，他们可能需要更大的最终植入物和额外的手术。此外，脂肪移植可提高总体满意度。TE/I患者的美学期望可能与DTI患者不同，强调以患者为中心的讨论对于优化NSM术后结局至关重要。
证据水平
3级。
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