Revisonal surgery after breast reconstruction in breast cancer in China: a cross-sectional study

doi:10.16139/j.1007-9610.2020.05.015

Abstract

Abstract:

Objective To investigate the application and influence factors of revisional surgery after breast reconstruction in breast cancer patients in China. Methods It is a cross-section national study by distributing questionnaires to 110 hospitals with more than 200 annual breast cancer surgeries each. The questionnaire included questions concerning the application, operative programme, influence factors and complications of revisional surgery including nipple reconstruction, fat grafting and symmetric surgery. Results A total of 96 (87.3%) in 110 hospitals had breast reconstruction and 87 (79.1%) hospitals with revisonal surgery. There was nipple reconstruction in 55 (50.0%) hospitals, fat grafting in 41 (37.3%) hospitals and symmetric surgery in 64 (58.2%) hospitals. Two types of revisonal surgery were performed in 31 (28.2%) hospitals and three types in 21 (19.1%) hospitals. The application of revisonal surgery did not have relationship significantly with local economy. There were more cases with nipple reconstruction (P=0.01) and symmetric surgery (P<0.01), as well as 2 or more than 2 types of revisonal surgery (P≤0.01) performed in hospitals which had more cases with breast cancer surgery. Conclusions Revisional surgery after breast reconstruction in breast cancer has been paid more attention in China and might be affected by the amount of breast cancer surgery in hospital, professional training and patient education.

Key words: Breast cancer, Breast reconstruction, Revisional surgery

CLC Number:

R737.9

WU Ke, XIU Bingqiu, GUO Rong, ZHANG Qi, LI Lun, YANG Benlong, WANG Jia, SU Yonghui, JI Weiru, SHAO Dingyi, SHAO Zhimin, WU Jiong. Revisonal surgery after breast reconstruction in breast cancer in China: a cross-sectional study[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 426-431.

Figures/Tables 2

References 17

[1]	Panchal H, Matros E. Current trends in postmastectomy breast reconstruction[J]. Plast Reconstr Surg, 2017, 140(5S Advances in Breast Reconstruction):7S-13S.
[2]	修秉虬, 郭瑢, 杨犇龙, 等. 中国乳腺癌术后乳房重建手术横断面调查研究[J]. 中华肿瘤杂志, 2019, 41(7):546-551.
[3]	Satteson ES, Brown BJ, Nahabedian MY, et al. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis[J]. Gland Surg, 2017, 6(1):4-13. doi: 10.21037/gs.2016.08.01 pmid: 28210547
[4]	Momoh AO, Colakoglu S, de Blacam C, et al. The impact of nipple reconstruction on patient satisfaction in breast reconstruction[J]. Ann Plast Surg, 2012, 69(4):389-393.
[5]	Clarke-Pearson EM, Lin AM, Hertl C, et al. Revisions in implant-based breast reconstruction: How does direct-to-implant measure up?[J]. Plast Reconstr Surg, 2016, 137(6):1690-1699. doi: 10.1097/PRS.0000000000002173 pmid: 27219225
[6]	Black CK, Graziano FD, Fan KL, et al. Combining abdominal flaps and implants in the breast reconstruction patient: a systematic and retrospective review of complications and outcomes[J]. Plast Reconstr Surg, 2019, 143(3):495e-503e.
[7]	Kling RE, Mehrara BJ, Pusic AL, et al. Trends in autologous fat grafting to the breast: a national survey of the American Society of Plastic Surgeons[J]. Plast Reconstr Surg, 2013, 132(1):35-46.
[8]	Orr JP, Sergesketter AR, Shammas RL, et al. Assessing the relationship between anxiety and revision surgery following autologous breast reconstruction[J]. Plast Reconstr Surg, 2019, 144(1):24-33.
[9]	Hurley CM, McArdle A, Joyce KM, et al. Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi breast reconstruction: a review of patient satisfaction[J]. Arch Plast Surg, 2018, 45(6):534-541.
[10]	中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师专委会. 乳腺肿瘤整形与乳房重建专家共识[J]. 中国癌症杂志, 2018, 28(6):439-480.
[11]	Cogliandro A, Barone M, Tenna S, et al. The role of lipofilling after breast reconstruction: evaluation of outcomes and patient satisfaction with BREAST-Q[J]. Aesthetic Plast Surg, 2017, 41(6):1325-1331. doi: 10.1007/s00266-017-0912-1 pmid: 28643007
[12]	Pearl RA, Leedham SJ, Pacifico MD. The safety of auto-logous fat transfer in breast cancer: lessons from stem cell biology[J]. J Plast Reconstr Aesthet Surg, 2012, 65(3):283-288.
[13]	Petit JY, Botteri E, Lohsiriwat V, et al. Locoregional recurrence risk after lipofilling in breast cancer patients[J]. Ann Oncol, 2012, 23(3):582-588. doi: S0923-7534(19)34427-8 pmid: 32018647
[14]	Mycckatyn TM, Wagner IJ, Mehrara BJ, et al. Cancer risk after fat transfer: a multicenter case-cohort study[J]. Plast Reconstr Surg, 2017, 139(1):11-18.
[15]	Yip JM, Watson DI, Tiggemann M, et al. Determinants of breast reconstruction outcome: how important is volume symmetry?[J]. J Plast Reconstr Aesthet Surg, 2015, 68(5):679-685.
[16]	Razdan SN, Panchal H, Albornoz CR, et al. Impact of contralateral symmetry procedures on long-term patient-reported outcomes following unilateral prosthetic breast reconstruction[J]. J Reconstr Microsurg, 2019, 35(2):124-128.
[17]	Smith ML, Clarke-Pearson EM, Vornovitsky M, et al. The efficacy of simultaneous breast reconstruction and contralateral balancing procedures in reducing the need for second stage operations[J]. Arch Plast Surg, 2014, 41(5):535-541. doi: 10.5999/aps.2014.41.5.535 pmid: 25276646

	项目	医院总数	开展乳头重建	开展脂肪移植	开展对称性手术
		110	55	41	64
地区^a)	东北	11	6	5	7
	华北	20	6	7	9
	华中	11	5	4	5
	华东	38	18	17	23
	华南	13	8	2	8
	西北	7	5	2	5
	西南	10	7	4	7
χ²值			7.07	4.19	3.52
P值			0.32	0.65	0.74
人均GDP（元）^b)	<45 000	22	10	7	12
	45 000~75 000	47	24	18	28
	>75 000	41	21	16	24
χ²值			0.23	0.36	0.16
P值			0.89	0.84	0.92
是否教学医院	教学	97	51	39	60
	非教学	13	4	2	4
χ²值			2.18	3.02	4.55
P值			0.14	0.08	0.03
医院类型	专科	29	15	5	16
	综合	81	40	36	48
χ²值			0.05	6.76	0.15
P值			0.83	<0.01	0.70
年手术总量（台）	<500	53	17	17	22
	500~1 000	33	21	14	24
	>1 000	24	17	10	18
χ²值			13.43	1.19	11.72
P值			0.01	0.55	<0.01

项目		医院总数	同时开展乳头重建、对称性手术	同时开展脂肪移植、对称性手术	同时开展乳头重建、脂肪移植	同时开展 3种手术
		110	42	26	26	21
地区
	东北	11	5	3	3	3
	华北	20	4	4	4	3
	华中	11	3	1	2	1
	华东	38	13	11	11	8
	华南	13	7	2	2	2
	西北	7	5	2	2	2
	西南	10	5	3	2	2
χ²值			9.08	2.92	1.66	2.03
P值			0.17	0.82	0.95	0.92
人均GDP（2017年计,元）
	<45 000	22	8	6	4	4
	45 000~75 000	47	19	10	11	9
	>75 000	41	15	10	11	8
χ²值			0.18	0.32	0.60	0.02
P值			0.92	0.85	0.74	0.99
是否教学医院
	教学	97	39	25	25	20
	非教学	13	3	1	1	1
χ²值			1.43	2.08	2.08	1.24
P值			0.23	0.15	0.15	0.27
医院类型
	专科	29	12	5	5	5
	综合	81	30	21	21	16
χ²值			0.17	0.89	0.89	0.09
P值			0.68	0.35	0.35	0.77
年手术总量
	<500	53	11	6	5	2
	500~1 000	33	17	11	13	11
	>1 000	24	14	9	8	8
χ²值			13.43	8.73	11.71	15.54
P值			<0.01	0.01	<0.01	<0.01
整形手术年限
	>15	6	4	2	2	1
	>10~15	17	7	6	6	6
	5~10	27	17	8	7	7
	<5	55	11	8	8	5
	未进行	15	3	2	3	2
χ²值			19.13	5.61	4.30	7.93
P值			<0.01	0.23	0.37	0.09