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Patient-Reported Quality of Life and Satisfaction with Cosmetic Outcomes After Breast Conservation and Mastectomy with and without Reconstruction: Results of a Survey of Breast Cancer Survivors
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Details:
  • Pubmed ID:
    25654742
  • Pubmed Central ID:
    PMC4512928
  • Funding:
    1U58DP00807-01/DP/NCCDPHP CDC HHS/United States
    K05 CA111340/CA/NCI NIH HHS/United States
    K05CA111340/CA/NCI NIH HHS/United States
    N01-PC-35139/PC/NCI NIH HHS/United States
    N01-PC-35145/PC/NCI NIH HHS/United States
    N01-PC-54404/PC/NCI NIH HHS/United States
    P30 CA008748/CA/NCI NIH HHS/United States
    R01 CA088370/CA/NCI NIH HHS/United States
    R01 CA088370/CA/NCI NIH HHS/United States
    R01 CA109696/CA/NCI NIH HHS/United States
    R01 CA109696/CA/NCI NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Purpose

    Although breast conservation is therapeutically equivalent to mastectomy for most early-stage breast cancer patients, an increasing number are pursuing mastectomy, which may be followed by breast reconstruction. We sought to evaluate long-term quality of life (QOL) and cosmetic outcomes after different locoregional management approaches, as perceived by patients themselves.

    Methods

    We surveyed women diagnosed with non-metastatic breast cancer from 2005-07, as reported to the Los Angeles and Detroit population-based SEER registries. We received responses from 2290 women approximately 9 months after diagnosis (73% response rate) and from 1536 of these 4 years later. We evaluated QOL and patterns and correlates of satisfaction with cosmetic outcomes overall, and more specifically within the subgroup undergoing mastectomy with reconstruction, using multivariable linear regression.

    Results

    Of the 1450 patients who responded to both surveys and had not recurred, 963 underwent breast conserving surgery, 263 mastectomy without reconstruction, and 222 mastectomy with reconstruction. Cosmetic satisfaction was similar between those receiving breast conservation and those receiving mastectomy with reconstruction. Among patients receiving mastectomy with reconstruction, reconstruction type and radiation receipt were associated with satisfaction (p<0.001), with an adjusted scaled satisfaction score of 4.7 for patients receiving autologous reconstruction without radiation, 4.4 for patients receiving autologous reconstruction and radiation therapy, 4.1 for patients receiving implant reconstruction without radiation, and 2.8 for patients receiving implant reconstruction and radiation.

    Discussion

    Patient-reported cosmetic satisfaction was similar after breast conservation and after mastectomy with reconstruction. In patients undergoing post-mastectomy radiation, use of autologous reconstruction may mitigate radiation's deleterious impact on cosmetic outcomes.