Abstract PS6-08: Quality of life following total mastectomy, breast-conserving surgery, and immediate breast reconstruction in patients with breast cancer: A multicenter cross-sectional study

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Abstract Background: The development of various treatment modalities has led to improved prognosis for patients with breast cancer. The diversity of individual values and lifestyles must be considered when deciding on a surgical approach. However, there is a paucity of reports assessing postoperative health-related quality of life (HR-QOL) in these populations from multiple perspectives. Therefore, this study aimed to identify differences in the HR-QOL and the impact on postoperative life for each surgical procedure using patient-reported outcomes in Japanese patients with breast cancer. Patients and Methods: This multi-institutional cross-sectional study included patients with primary breast cancer who underwent total mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR) between August 2013 and July 2021. Data were collected using a questionnaire administered postoperatively between October 2022 and March 2024 to patients who provided consent. BREAST-Q was administered to investigate postoperative HR-QOL and satisfaction. An ad-hoc questionnaire was used to investigate the effects on postoperative life. The BREAST-Q scores and impacts of the three surgical procedures on postoperative life were compared. One-way ANOVA was used to compare the differences in BREAST-Q scores among these groups. Multiple regression analysis was performed to evaluate the relationship between BREAST-Q scores, clinical factors, and social backgrounds. The differences in the impact on postoperative life among these groups were compared using the chi-square test. Results: The questionnaire response rate was 90.2% (577/640). The analysis included 194 patients with MT, 185 with BCS, and 194 with IBR, with mean ages of 58.1, 54.8, and 48.2 years, respectively (p < 0.001). The rates of clinical tumor size (T) ≥ 3 (p < 0.001), clinical nodal stage (N) (p = 0.003), axillary lymph node dissection (p < 0.001), and adjuvant chemotherapy (p < 0.001) were significantly higher in the MT group than in the BCS and IBR groups. Additionally, the frequency of Grade ≥ 3 complications was significantly higher in the IBR group than in the MT and BCS groups (p < 0.001). Of the 198 patients in the IBR group, implant reconstruction was performed in 72.2% of patients, nipple-sparing mastectomy in 39.9%, and one-stage reconstruction in 21.7%. Significant differences were observed in satisfaction with the breasts (SB), psychosocial well-being (PSW), and sexual well-being (SW) using the BREAST-Q among the groups. The SB scores for the MT, BCS, and IBR groups were 46.7, 66.7, and 60.5, respectively (p < 0.001). The PSW scores were 53.3 (MT), 62.9 (BCS), and 61.5 (IBR) (p < 0.001). The SW scores were 31.6 (MT), 44.5 (BCS), and 41.3 (IBR) (p < 0.001). Multiple regression analysis indicated that procedures (SB: MT vs. BCS or IBR, p < 0.001; PSW: MT vs. BCS, p = 0.001; MT vs. IBR, p = 0.027; SW: MT vs. BCS, p = 0.005; MT vs. IBR, p = 0.041) and age (SB, p = 0.006; PSW, p < 0.001; SW, p = 0.016) were significant factors affecting the patients’ quality of life. When comparing the impact on postoperative life between procedures, the proportion of women who did not experience any negative impact on their postoperative lives was the highest in the BCS group (p < 0.001), whereas the proportion of women who developed clothing issues was the highest in the MT group. Conclusions: Surgical procedure and age may have significant impacts on postoperative HR-QOL in women with breast cancer. Women with breast cancer who underwent BCS or IBR had a significantly high aesthetic breast satisfaction and psychosocial and sexual well-being. Postoperative life was significantly less affected in patients who underwent BCS. Citation Format: Hirohito Seki, Maho Kato, Takako Komiya, Nobuko Tamura, Yoshihiro Sowa, Hirotsugu Isaka, Yutaka Nishida, Jyunji Takano, Miho Saiga. Quality of life following total mastectomy, breast-conserving surgery, and immediate breast reconstruction in patients with breast cancer: A multicenter cross-sectional study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS6-08.

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