Tradeoffs Associated With Contralateral Prophylactic Mastectomy in Women Choosing Breast Reconstruction Results of a Prospective Multicenter Cohort
Tradeoffs Associated With Contralateral Prophylactic Mastectomy in Women Choosing Breast Reconstruction Results of a Prospective Multicenter Cohort
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DOI：
10.1097/sla.0000000000001840
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发表时间：
2017-07-01
影响因子：
9
通讯作者：
Matros, Evan
中科院分区：
文献类型：
--
作者：
Momoh, Adeyiza O.;Cohen, Wess A.;Matros, Evan
目的：评估单侧乳腺癌患者单侧和双侧乳房重建术后的发病率和患者报告的结果。背景：对于接受对侧预防性乳房切除术 (CPM) 和乳房重建的患者所经历的发病率和生活质量变化知之甚少。这些信息对于单侧乳腺癌患者的决策非常有价值。方法：这项前瞻性观察研究招募了因单侧乳腺癌而接受乳房切除术和乳房重建的女性。记录接受单侧或双侧乳房切除术的患者植入和自体乳房重建后的术后并发症。测量术前和 1 年患者报告的结果。我们进行了单变量检验和逻辑回归分析，研究了重建方法、偏侧性和危险因素对手术并发症发生率、患者满意度和焦虑的影响。 结果：我们确定了 1144 名接受单侧（47.2%）或双侧（52.8%）乳房重建术的女性。与单侧重建相比，双侧自体重建（比值比 1.73，95% 置信区间 1.07-2.81）和种植体重建（比值比 1.73，95% 置信区间 1.22-2.47）与更高的并发症风险相关。与单侧种植体重建相比，选择双侧种植体重建的女性基线焦虑程度更高（P = 0.001）。术后各组之间的焦虑水平没有差异。术后，选择 CPM 假体重建的女性比单侧重建的女性对自己的乳房更满意（P = 0.034）。结论：尽管 CPM 和重建后观察到术后并发症较高，但这些手术与接受假体重建的女性焦虑水平降低和乳房满意度提高相关。
Objective: Assess postoperative morbidity and patient-reported outcomes after unilateral and bilateral breast reconstruction in patients with unilateral breast cancer.Background: Relatively little is known about the morbidity associated with and changes in quality of life experienced by patients who undergo contralateral prophylactic mastectomy (CPM) and breast reconstruction. This information would be valuable for decision making in patients with unilateral breast cancer.Methods: Women undergoing mastectomy and breast reconstruction for unilateral breast cancer were recruited for this prospective observational study. Postoperative complications after implant and autologous breast reconstruction in patients undergoing unilateral or bilateral mastectomy were recorded. Preoperative and 1 year patient-reported outcomes were measured. Univariate tests and logistic regression analyses were performed, studying the effects of reconstructive method, laterality, and risk factors on surgical complication rates, patient satisfaction, and anxiety.Results: We identified 1144 women who underwent either unilateral (47.2%) or bilateral (52.8%) mastectomies with reconstruction. Bilateral autologous (odds ratio 1.73, 95% confidence interval 1.07-2.81) and implant reconstructions (odds ratio 1.73, 95% confidence interval 1.22-2.47) were associated with a higher risk of complications compared with unilateral reconstructions. Baseline anxiety was greater in women who chose bilateral compared with unilateral implant reconstructions (P = 0.001). There was no difference in anxiety levels between groups postoperatively. Postoperatively, women who chose CPM with implant reconstructions were more satisfied with their breasts than women with unilateral reconstructions (P = 0.034).Conclusions: Although higher postoperative complications were observed after CPM and reconstruction, these procedures were associated with decreased anxiety levels and improved satisfaction with breasts for women who underwent implant reconstructions.