The Necessity of the Nipple: Redefining Completeness in Breast Reconstruction.
The Necessity of the Nipple: Redefining Completeness in Breast Reconstruction.
复制标题
乳头的必要性：重新定义乳房重建的完整性。
DOI：
10.1097/sap.0000000000000943
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发表时间：
2017
影响因子：
1.5
通讯作者：
Taub,PeterJ
中科院分区：
文献类型：
--
作者：
Weissler,EHope;Schnur,JulieB;Lamelas,AndreasM;Cornejo,Marisa;Horesh,Elan;Taub,PeterJ
方法回顾性分析某医院电子病历系统中乳房再造患者的随访情况。卡方检验和独立t检验用于识别与NAC重构缺失相关的变量；采用相关变量（P< 0.05）建立二元逻辑回归。结果共回顾433例患者。重建在503天（范围2 - 3652天）内平均进行4.0±2.0次手术。112例患者有NAC重建或纹身（25.9%），73例（17.6%）两者都有，226例（54.6%）两者都没有。在多变量分析中，任何植入物移除史与NAC重建机会降低93.4%相关（P= 0.002），而预防性或早期乳房切除术与NAC重建机会增加52.9%相关（P= 0.009）。结论：超过一半的患者没有完成任何NAC重建。晚期癌症患者和有种植体移除史的患者不太可能进行NAC重建。不完全重建的高流行率表明，乳房重建完成的经典定义为需要NAC重建可能已经过时或不适用于所有人群。相反，“完成”应该被认为是一种因人而异的主观判断。
MethodsBreast reconstruction patients with follow-up in a single institution's electronic medical record system were reviewed. Chi-squared and independent t-tests were used to identify variables associated with lack of NAC reconstruction; associated variables (P< 0.05) were used to build a binary logistic regression.ResultsFour hundred thirty-three patients were reviewed. Reconstructions consisted of an average of 4.0±2.0 procedures over 503 (range, 2–3,652) days. One hundred twelve patients had NAC reconstruction or tattooing (25.9%) and 73 (17.6%) had both—226 women (54.6%) had neither. On multivariate analysis, a history of any implant removal was associated with a 93.4% decreased chance of NAC reconstruction (P= 0.002), whereas prophylactic or early-stage mastectomy was associated with 52.9% increased chances of NAC reconstruction (P= 0.009).ConclusionsOver half of the present cohort did not complete any NAC reconstruction. Patients with later-stage cancer and a history of implant removal were less likely to have NAC reconstruction. The high prevalence of incomplete reconstructions suggests that the classical definition of breast reconstruction completion as requiring NAC reconstruction may be outdated or not applicable to all populations. Instead,“completion” should be considered a subjective determination varying between patients.