Choice of Breast Reconstruction After Mastectomy Affects Satisfaction, Quality of Life

Quality of life was measured using the BREAST-Q questionnaire. This validated instrument is specific for evaluating patient reports on breast surgery outcomes and is calibrated to detect differences over time between specific procedure groups and patients.² The researchers report that the BREAST-Q has substantially improved clinicians’ understanding of how patients regard the outcomes of their breast reconstruction procedure. Participants completed the BREAST-Q questionnaire up to 90 days prior to surgery, and at 1, 2, 3, and 4 years after surgery.

Five areas of the BREAST-Q reconstruction module were evaluated: satisfaction with breasts, sexual well-being, psychosocial well-being, physical well-being of the chest, and physical well-being of the abdomen. Using conversion tables, responses were converted on a scale of 0 to 100, where the higher numbers represented greater satisfaction or quality of life.

Two years after their breast reconstruction, 1217 patients (60.5%) completed the BREAST-Q survey. But response rates diminished in the later years of the study. At 3 years postreconstruction, 422 survivors (21.0%) completed the questionnaire, and at 4 years, 205 (10.2%) completed the questionnaire.¹

Physical well-being was rated higher in the breast area 2 years after autologous reconstruction but worse in the abdominal area compared with responses from those who underwent implant reconstruction. Survivors who had undergone autologous reconstruction reported a high level of satisfaction with their breasts and with their quality of life, as demonstrated by their psychosocial, physical, and sexual well-being scores. However, abdominal well-being scores in this group worsened during the acute postoperative period from baseline to 1 year and did not return to that level even 2 years after breast reconstruction.

By contrast, the women who underwent implant-based reconstruction were initially satisfied with their breasts and their sexual well-being, but a decrease in scores indicated their satisfaction gradually deteriorated over time. ¹

BREAST-Q scoring demonstrated that patients who underwent autologous reconstruction reported significantly greater satisfaction with their breasts (BREAST-Q score difference, 7.94), sexual well-being (difference, 5.53), and psychosocial well-being (difference, 3.23) at 2 years compared with those who underwent implant reconstruction.¹