Objective: To explore the current clinical practice of implant-based breast reconstruction (IBBR) in China. Methods: The current survey was sponsored by Chinese Anti-Cancer Association, Committee of Breast Cancer Society and Chinese Society of Breast Surgeons. A survey was mailed to 110 hospitals in China, which have more than 200 breast cancer operations performed in 2017. The survey mainly included questions on the clinical practice of IBBR, sociodemographic and geographical factors associated with IBBR practice, reasons and concerns for selecting IBBR, type and timing of breast reconstruction, and the complications of IBBR. Data were analyzed using χ(2) test, Fisher's exact test or Kruskal-Wallis rank sum test. Results: IBBR was available in 86.4% (95/110) included hospitals. It was predominantly performed breast reconstruction surgery, the proportion of IBBR in all the breast reconstruction was 65.75% (4 296/6 534). However, the rate of IBBR in all the patients received mastectomy was only 7.06% (4 296/60 877). Among all the included hospitals, the number of implant reconstructions performed in 2017 was 24 (57.5) cases (M(Q(R)), range: 2-565 cases). Factors associated with the performance of IBBR including regional per capita gross domestic product (H=10.47, P=0.005) and annual surgery volume (H=8.30, P=0.016). The main reasons for choosing IBBR were relatively simple surgical procedure, short learning curve and short operation time. The effects of adjuvant radiotherapy on prosthesis, postoperative complications and patient satisfaction were the main concerns for implant reconstruction. Compared with delay reconstruction, a higher proportion of IBBR was observed in immediate reconstruction (83.1% vs. 62.0%, χ(2)=12.522, P=0.000). In all, 10.5% (10/95) hospitals reported more than 10% grade Ⅲ to Ⅳ capsular contracture. The incidence of infections need surgical intervention was reported between 10% and 20% by 4.2% (4/95) hospitals. Hospitals with 6% to 10% implant rupture and 6% to 15% implant removal were 1.1% (1/95) and 4.2% (4/95) respectively. Conclusions: IBBR was the most common used surgery in breast reconstruction after mastectomy. However, the proportion of IBBR in patients after mastectomy was still low. Reginal economy, surgery volume of hospitals, lack of specialty training program and the concern about complications and patient's satisfaction were the factors affecting the development of IBBR.
目的： 了解我国植入物乳房重建的开展现状。 方法： 本研究由中国抗癌协会乳腺癌专业委员会及中国医师协会外科医师分会乳腺外科医师专业委员会发起，在全国范围内选择2017年乳腺癌手术量大于200例的110家医院进行问卷调查。调查项目包括植入物乳房重建的应用现状、影响应用的因素、选择的原因及顾虑、应用时机的选择及其并发症。采用χ(2)检验、Fisher确切概率法或Kruskal-Wallis秩和检验对数据进行分析。 结果： 参与调查的医院中，86.4%（95/110）已开展植入物乳房重建。植入物乳房重建占所有乳房重建手术的65.75%（4 296/6 534）。接受植入物乳房重建的乳房全切除患者的比例为7.06%（4 296/60 877），各医院植入物乳房重建手术量为24（57.5）例[M（Q(R)），范围：2~565例]。植入物乳房重建在乳房全切除术后患者中的开展比例与地区人均国内生产总值（H=10.47，P=0.005）、医院年手术量（H=8.30，P=0.016）有关。选择植入物乳房重建的主要原因为操作简单、学习曲线短及手术时间较短。辅助放疗对假体的影响、术后并发症及患者满意度是选择植入物乳房重建的主要顾虑。相较于延期乳房重建，植入物乳房重建在即刻乳房重建中占比更高（83.2%比60.0%，χ(2)=12.522，P=0.000）。植入物相关严重并发症发生率方面，10.5%（10/95）的医院3~4级包囊挛缩发生率>10%，4.2%（4/95）的医院需要外科干预的感染发生率为10%~20%，扩张器或假体破裂发生率为6%~10%、植入物取出或重建失败发生率为6%~15%的医院分别为1.1%（1/95）和4.2%（4/95）。 结论： 植入物乳房重建已成为乳腺癌手术后最常用的乳房重建方式。然而其在乳房全切除术患者中占比仍较低。地区经济发展水平、医院手术量、专科医师的培训及对植入物乳房重建并发症和患者满意度的顾虑是影响其发展的主要因素。.
Keywords: Breast cancer; Breast implants; Mammaplasty; Questionnaires.