Regret and Quality of Life After Mastectomy With or Without Reconstruction

Lucio Fortunato; Andrea Loreti; Giuliana Cortese; Diana Spallone; Vito Toto; Francesco Cavaliere; Massimo Farina; Massimo La Pinta; Elena Manna; Laura Detto; Tiziano Pallara

doi:10.1016/j.clbc.2019.11.005

Regret and Quality of Life After Mastectomy With or Without Reconstruction

Clin Breast Cancer. 2021 Jun;21(3):162-169. doi: 10.1016/j.clbc.2019.11.005. Epub 2020 Oct 14.

Authors

Affiliations

¹ Breast Center, Department of Surgery, San Giovanni-Addolorata Hospital Rome, Rome, Italy.
² Department of Statistical Sciences, University of Padova, Padova, Italy.
³ Breast Center, Department of Surgery, San Giovanni-Addolorata Hospital Rome, Rome, Italy. Electronic address: dspallone@hsangiovanni.roma.it.
⁴ First Surgical Division, Department of Surgery, San Giovanni-Addolorata Hospital Rome, Rome, Italy.

PMID: 33744100
DOI: 10.1016/j.clbc.2019.11.005

Abstract

Background: Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QoL) of women so treated, with or without breast reconstruction (BR).

Patients and methods: A total of 709 patients underwent mastectomy with or without BR between 2002 and 2012 at one institution. Among 468 surviving patients, a 60-query QoL questionnaire on personal issues including some European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire items was presented either by email, letter, or telephone interview.

Results: Of those questioned, 328 patients participated, whereas 140 (30%) declined the invitation or were unavailable. The median age was 63 years (range, 30-93 years). Stage I or II of disease was recorded in 73% of patients. Immediate BR was performed in 168 (51%) of 328 patients. Of the remaining patients, only 7 (4%) of 160 proceeded to delayed BR. Younger women had significantly worse Emotional Functioning and Social Functioning (SF) scores (P < .001), independently of tumor stage, and immediate BR improved that (P = .02). SF score was also worsened by chemotherapy (P = .03). Cognitive Functioning score was independent of age, BR, stage, or adjuvant therapies. Body Image and Sexual Functioning scores improved with BR (P < .03), and age was a strong co-variable (P < .001). On multivariate analysis, immediate BR was correlated with age and preoperative plastic surgery consultation. Some 68 (21%) of 328 patients regretted their decision or were disappointed with their choice regarding BR.

Conclusions: Younger patients with breast cancer report a worse impact on their Emotional Functioning and SF scores after mastectomy, both of which are improved by BR. Reconstructing the breast at the time of mastectomy has a significant impact on Body Image and Sexual Functioning scores. A preoperative plastic surgeon consultation improves the rate of immediate BR, whereas delayed reconstruction is rarely adopted. Some 20% of patients are disappointed in or regret their decision regarding BR. We need to improve our management in consideration of these findings.

Keywords: Breast cancer; Breast reconstruction; Mastectomy; Psychological consequences; Quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological
Breast Neoplasms / psychology*
Breast Neoplasms / surgery*
Decision Making
Female
Happiness
Humans
Mammaplasty / psychology*
Mastectomy / psychology*
Mastectomy, Segmental / psychology
Patient Satisfaction*
Quality of Life