Skip to main content

Advertisement

SpringerLink
Log in

A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Many factors influence decisions regarding choice of breast-conserving surgery (BCS) versus mastectomy with reconstruction for early invasive breast cancer. The purpose of this study was to compare patient satisfaction following BCS and mastectomy with implant reconstruction (M-iR) utilizing the BREAST-Q patient-reported outcome measure.

Methods

Women with stage I or II breast cancer undergoing BCS or M-iR who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time.

Results

Our study group was composed of 3233 women; 2026 (63%) had BCS, 123 (3.8%) had nipple-sparing mastectomy, and 1084 (34%) had skin-sparing or total mastectomy. Median time from surgery to BREAST-Q was 205 days for BCS and 639 days for M-iR (p < 0.001). Regardless of type of surgery, breast satisfaction scores decreased significantly over time (p < 0.001), whereas psychosocial (p = 0.001) and sexual (p = 0.004) well-being scores increased significantly over time. BCS was associated with significantly higher scores over time compared with M-iR across all subscales (all p < 0.001). Radiation was significantly associated with decreased scores over time across all subscales (all p < 0.05).

Conclusions

Breast satisfaction and quality-of-life scores were higher for BCS compared with M-iR in early-stage invasive breast cancer. These findings may help in counseling women who have a choice for surgical treatment. Breast satisfaction scores decreased over time in all women, highlighting the need for further evaluation with longer follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.

    Article  Google Scholar 

  2. Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27(15):2466–73.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zumsteg ZS, Morrow M, Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013;20(11):3469–76.

    Article  PubMed  PubMed Central  Google Scholar 

  4. El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jonczyk MM, Jean J, Graham R, Chatterjee A. Trending towards safer breast cancer surgeries? Examining acute complication rates from a 13-year NSQIP analysis. Cancers (Basel). 2019. https://doi.org/10.3390/cancers11020253.

    Article  Google Scholar 

  6. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9–16.

    Article  PubMed  Google Scholar 

  7. Albornoz CR, Matros E, Lee CN, et al. Bilateral mastectomy versus breast-conserving surgery for early-stage breast cancer: the role of breast reconstruction. Plast Reconstr Surg. 2015;135(6):1518–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32(9):919–26.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sabino J, Lucas DJ, Shriver CD, Vertrees AE, Valerio IL, Singh DP. NSQIP analysis: increased immediate reconstruction in the treatment of breast cancer. Am Surg. 2016;82(6):540–5.

    PubMed  Google Scholar 

  10. Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. 2017;35(22):2499–506.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Momoh AO, Cohen WA, Kidwell KM, et al. Tradeoffs associated with contralateral prophylactic mastectomy in women choosing breast reconstruction: results of a prospective multicenter cohort. Ann Surg. 2017;266(1):158–64.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Atisha DM, Tessiatore KM, Rushing CN, Dayicioglu D, Pusic A, Hwang S. A national snapshot of patient-reported outcomes comparing types of abdominal flaps for breast reconstruction. Plast Reconstr Surg. 2019;143(3):667–77.

    Article  CAS  PubMed  Google Scholar 

  13. Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129(2):293–302.

    Article  CAS  PubMed  Google Scholar 

  14. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–53.

    Article  CAS  PubMed  Google Scholar 

  15. BREAST-Q Website. http://qportfolio.org/breast-q/. Accessed 6 May 2019.

  16. Romanoff A, Zabor EC, Stempel M, Sacchini V, Pusic A, Morrow M. A comparison of patient-reported outcomes after nipple-sparing mastectomy and conventional mastectomy with reconstruction. Ann Surg Oncol. 2018;25(10):2909–16.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nichols HB, Berrington de Gonzalez A, Lacey JV Jr, Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29(12):1564–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.

    Article  PubMed  Google Scholar 

  19. King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158–64.

    Article  PubMed  Google Scholar 

  20. Howes BH, Watson DI, Xu C, Fosh B, Canepa M, Dean NR. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: a case-controlled cohort study. J Plast Reconstr Aesthet Surg. 2016;69(9):1184–91.

    Article  PubMed  Google Scholar 

  21. Cocquyt VF, Blondeel PN, Depypere HT, et al. Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg. 2003;56(5):462–70.

    Article  PubMed  Google Scholar 

  22. Jagsi R, Li Y, Morrow M, et al. 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. Ann Surg. 2015;261(6):1198–206.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 2018;153(10):891–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chand ND, Browne V, Paramanathan N, Peiris LJ, Laws SA, Rainsbury RM. Patient-reported outcomes are better after oncoplastic breast conservation than after mastectomy and autologous reconstruction. Plast Reconstr Surg Glob Open. 2017;5(7):e1419.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Catsman C, Beek MA, Voogd AC, Mulder PGH, Luiten EJT. The COSMAM TRIAL a prospective cohort study of quality of life and cosmetic outcome in patients undergoing breast conserving surgery. BMC Cancer. 2018;18(1):456.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rechis R, Boerner L, Nutt S, Shaw K, Berno D, Duchover Y. How cancer has affected post-treatment survivors: a LIVESTRONG report. 1–27. https://www.livestrong.org/sites/default/files/what-we-do/reports/LSSurvivorSurveyReport.pdf. Accessed 10 Apr 2019.

  27. Aerts L, Christiaens MR, Enzlin P, Neven P, Amant F. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast. 2014;23(5):629–36.

    Article  CAS  PubMed  Google Scholar 

  28. Parker PA, Youssef A, Walker S, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol. 2007;14(11):3078–89.

    Article  PubMed  Google Scholar 

  29. Gass JS, Onstad M, Pesek S, et al. Breast-specific sensuality and sexual function in cancer survivorship: Does surgical modality matter? Ann Surg Oncol. 2017;24(11):3133–40.

    Article  PubMed  Google Scholar 

  30. Avis NE, Crawford S, Manuel J. Psychosocial problems among younger women with breast cancer. Psychooncology. 2004;13(5):295–308.

    Article  PubMed  Google Scholar 

  31. Ganz PA, Desmond KA, Belin TR, Meyerowitz BE, Rowland JH. Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol. 1999;17(8):2371–80.

    Article  CAS  PubMed  Google Scholar 

  32. Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16(2):501–14.

    Article  CAS  PubMed  Google Scholar 

  33. Bentzen SM, Turesson I, Thames HD. Fractionation sensitivity and latency of telangiectasia after postmastectomy radiotherapy: a graded-response analysis. Radiother Oncol. 1990;18(2):95–106.

    Article  CAS  PubMed  Google Scholar 

  34. Bentzen SM, Thames HD, Overgaard M. Latent-time estimation for late cutaneous and subcutaneous radiation reactions in a single-follow-up clinical study. Radiother Oncol. 1989;15(3):267–74.

    Article  CAS  PubMed  Google Scholar 

  35. Ricci JA, Epstein S, Momoh AO, Lin SJ, Singhal D, Lee BT. A meta-analysis of implant-based breast reconstruction and timing of adjuvant radiation therapy. J Surg Res. 2017;218:108–16.

    Article  PubMed  Google Scholar 

  36. Turesson I. The progression rate of late radiation effects in normal tissue and its impact on dose–response relationships. Radiother Oncol. 1989;15(3):217–26.

    Article  CAS  PubMed  Google Scholar 

  37. Albornoz CR, Matros E, McCarthy CM, et al. Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction. Ann Surg Oncol. 2014;21(7):2159–64.

    Article  PubMed  Google Scholar 

  38. Sinnott CJ, Persing SM, Pronovost M, Hodyl C, McConnell D, Ott Young A. Impact of postmastectomy radiation therapy in prepectoral versus subpectoral implant-based breast reconstruction. Ann Surg Oncol. 2018;25(10):2899–908.

    Article  PubMed  Google Scholar 

  39. Study of Radiation Fractionation on Patient Outcomes After Breast REConstruction (FABREC) for Invasive Breast Carcinoma. https://clinicaltrials.gov/ct2/show/NCT03422003. Accessed 10 Apr 2019.

  40. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Meghan R. Flanagan MD, Anya Romanoff MD, Sarah Fuzesi MD, Michelle Stempel MPH, Monica Morrow MD & Mary L. Gemignani MD, MPH

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily C. Zabor DrPH

  3. Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Babak J. Mehrara MD

  4. Plastic and Reconstructive Surgery Division, Brigham and Women’s Hospital, Boston, MA, USA

    Andrea L. Pusic MD

Authors
  1. Meghan R. Flanagan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily C. Zabor DrPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anya Romanoff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Fuzesi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michelle Stempel MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Babak J. Mehrara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Monica Morrow MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea L. Pusic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mary L. Gemignani MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary L. Gemignani MD, MPH.

Ethics declarations

Disclosures

The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center, and this study was presented in podium format at the 20th Annual Meeting of the American Society of Breast Surgeons, April 30–May 5, 2019, Dallas, TX. Dr. Babak Mehrara has received salary support for a research project sponsored by aTyr Corporation, and Dr. Monica Morrow has received speaking honoraria from Genomic Health and Roche. Dr. Andrea Pusic is a co-developer of the BREAST-Q and receives royalties when the questionnaire is used in for-profit industry-sponsored clinical trials.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Flanagan, M.R., Zabor, E.C., Romanoff, A. et al. A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction. Ann Surg Oncol 26, 3133–3140 (2019). https://doi.org/10.1245/s10434-019-07548-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-07548-9

Search

Navigation