Abstract：
BACKGROUND: This study aims to explore the ideal breast size by assessing the relationship between mastectomy to free flap weight ratio and complications as well as patient-reported outcomes in autologous breast reconstruction (ABR).
METHODS: A retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights. The patients were grouped as \"maintained\" if the flap weight was within 10% of the mastectomy weight. Patients with a weight difference greater than 10% were used to declare \"downsized\" or \"upsized.\" Outcomes included complications and four domains of the BREAST-Q at 1-year postoperatively.
RESULTS: Three hundred and fifty-nine patients were included in the analysis, of which 112 were downsized, 91 maintained, and 156 upsized, respectively. Presence of complications did not significantly differ among the groups. At 1-year postoperatively, Sexual Well-being significantly differed (p = 0.033). Between preoperative and 1 year, patients who upsized experienced an improvement in Satisfaction with Breasts by 16 points (p < 0.001), while patients who downsized experienced a decline in Physical Well-being of the Chest by 7 points (p = 0.016). Multivariable linear regression model showed that Sexual Well-being was 13 points lower in the downsized cohort than in the maintained cohort (β = -13, 95% confidence interval: -21 to -5.4; p = 0.001).
CONCLUSIONS: Although complication rates do not significantly differ between the three cohorts, patients who downsize may have lower Sexual Well-being postoperatively. Surgeons should consider our preliminary findings to counsel patients preoperatively about the predicted breast size and the impact of downsizing on sexual health.
METHODS: A retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights. The patients were grouped as \"maintained\" if the flap weight was within 10% of the mastectomy weight. Patients with a weight difference greater than 10% were used to declare \"downsized\" or \"upsized.\" Outcomes included complications and four domains of the BREAST-Q at 1-year postoperatively.
RESULTS: Three hundred and fifty-nine patients were included in the analysis, of which 112 were downsized, 91 maintained, and 156 upsized, respectively. Presence of complications did not significantly differ among the groups. At 1-year postoperatively, Sexual Well-being significantly differed (p = 0.033). Between preoperative and 1 year, patients who upsized experienced an improvement in Satisfaction with Breasts by 16 points (p < 0.001), while patients who downsized experienced a decline in Physical Well-being of the Chest by 7 points (p = 0.016). Multivariable linear regression model showed that Sexual Well-being was 13 points lower in the downsized cohort than in the maintained cohort (β = -13, 95% confidence interval: -21 to -5.4; p = 0.001).
CONCLUSIONS: Although complication rates do not significantly differ between the three cohorts, patients who downsize may have lower Sexual Well-being postoperatively. Surgeons should consider our preliminary findings to counsel patients preoperatively about the predicted breast size and the impact of downsizing on sexual health.
摘要：
背景：本研究旨在通过评估自体乳房重建（ABR）中乳房切除术与游离皮瓣重量比与并发症之间的关系以及患者报告的结果来探索理想的乳房大小。
方法：完成了对双侧即刻ABR患者行乳房切除术和皮瓣重量的回顾性回顾。根据乳房切除术与皮瓣重量的比率将患者分为三组。如果皮瓣重量在乳房切除术重量的10％以内，则将患者分组为“维持”。体重差异大于10％的患者被用来声明“缩小”或“扩大”。“结果包括并发症和术后1年的乳房Q的四个领域。
结果：三百五十九名患者被纳入分析，其中112个被缩小了，91维护，156个放大了，分别。两组之间并发症的存在没有显着差异。术后1年，性幸福感显著不同(p=0.033)。在术前和一年之间，增大的患者对乳房的满意度提高了16分（p<0.001），而缩小规模的患者的胸部健康状况下降了7分（p=0.016）。多变量线性回归模型显示，缩小队列的性功能幸福感比维持队列低13个百分点（β=-13，95％置信区间：-21至-5.4；p=0.001）。
结论：尽管三个队列的并发症发生率没有显著差异，缩小规模的患者术后性生活幸福感可能较低。外科医生应考虑我们的初步发现，以术前就预测的乳房大小以及缩小对性健康的影响向患者提供咨询。
方法：完成了对双侧即刻ABR患者行乳房切除术和皮瓣重量的回顾性回顾。根据乳房切除术与皮瓣重量的比率将患者分为三组。如果皮瓣重量在乳房切除术重量的10％以内，则将患者分组为“维持”。体重差异大于10％的患者被用来声明“缩小”或“扩大”。“结果包括并发症和术后1年的乳房Q的四个领域。
结果：三百五十九名患者被纳入分析，其中112个被缩小了，91维护，156个放大了，分别。两组之间并发症的存在没有显着差异。术后1年，性幸福感显著不同(p=0.033)。在术前和一年之间，增大的患者对乳房的满意度提高了16分（p<0.001），而缩小规模的患者的胸部健康状况下降了7分（p=0.016）。多变量线性回归模型显示，缩小队列的性功能幸福感比维持队列低13个百分点（β=-13，95％置信区间：-21至-5.4；p=0.001）。
结论：尽管三个队列的并发症发生率没有显著差异，缩小规模的患者术后性生活幸福感可能较低。外科医生应考虑我们的初步发现，以术前就预测的乳房大小以及缩小对性健康的影响向患者提供咨询。
