Table_1_Long-Term Patient Satisfaction and Quality of Life Following Breast Reconstruction Using the BREAST-Q: A Prospective Cohort Study.docx

BackgroundBreast reconstruction is a promising surgical technique to improve health-related quality of life (HRQoL) in patients with breast cancer. However, the long-term risk factors associated with HRQoL after breast surgery are still unclear. Our aim was to evaluate breast satisfaction and HRQoL following breast reconstruction to identify clinical factors associated with each domain of BREAST-Q in the long-term. MethodsPatient-reported BREAST-Q outcomes were analyzed 1 and 5 years after breast reconstruction in a single-blinded, prospective study. Multiple regression analysis was performed to identify the risk and protective factors associated with BREAST-Q scores. These scores at 1 and 5 years were also compared across three types of operation: mastectomy only, tissue expander/implant (TE/Imp), and a deep inferior epigastric perforator (DIEP) flap. ResultsSurveys were completed by 141 subjects after 1 year and 131 subjects after 5 years. Compared to mastectomy only, breast reconstruction was significantly associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p < 0.001; DIEP, p < 0.001), higher body mass index (BMI) resulted in lower “Satisfaction with breasts” (p = 0.004), and a history of psychiatric or neurological medication was significantly associated with “Physical well-being” at 1-year postoperatively (p = 0.02). At 5 years, reconstructive procedures were significantly positively associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p = 0.03; DIEP, p < 0.001), and a bilateral procedure was a significant risk factor for lower “Psychosocial well-being” (p = 0.02). ConclusionsThe results of this study show that breast reconstruction improves “Satisfaction with Breasts” and “Psychosocial well-being” compared to mastectomy. Among all three types of operation, DIEP gave the best scores at 5 years postoperatively. Thus, autologous reconstruction is recommended for promotion of long-term HRQoL after breast surgery.背景 乳房重建是改善乳腺癌患者健康相关生活质量（Health-Related Quality of Life, HRQoL）的极具前景的外科技术。然而，乳房手术后与HRQoL相关的长期危险因素仍不明确。本研究旨在评估乳房重建术后的乳房满意度与HRQoL，以明确长期随访中与BREAST-Q各维度相关的临床因素。 方法 本研究为单盲前瞻性研究，对乳房重建术后1年及5年的患者报告BREAST-Q结局进行分析。采用多元回归分析明确与BREAST-Q评分相关的危险因素与保护因素，并比较三种手术方式（仅乳房切除术、组织扩张器/植入术（TE/Imp）、腹壁下深动脉穿支皮瓣（DIEP flap））术后1年及5年的评分情况。 结果 术后1年共有141名受试者完成问卷调研，术后5年则为131名。与仅行乳房切除术者相比，行乳房重建者的"乳房满意度"（TE/Imp，p < 0.001；DIEP，p < 0.001）与"心理社会健康状况"（TE/Imp，p < 0.001；DIEP，p < 0.001）均显著更高；较高的身体质量指数（Body Mass Index, BMI）与更低的"乳房满意度"相关（p = 0.004）；术后1年时，精神类或神经类药物用药史与"躯体健康状况"显著相关（p = 0.02）。术后5年时，乳房重建手术仍与更高的"乳房满意度"（TE/Imp，p < 0.001；DIEP，p < 0.001）及"心理社会健康状况"（TE/Imp，p = 0.03；DIEP，p < 0.001）显著正相关，而双侧乳房手术则是"心理社会健康状况"较低的显著危险因素（p = 0.02）。 结论 本研究结果显示，与仅行乳房切除术相比，乳房重建可提升患者的"乳房满意度"与"心理社会健康状况"。三种手术方式中，DIEP皮瓣术在术后5年时的评分最优。因此，推荐采用自体组织重建术以改善乳房手术后患者的长期HRQoL。