Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors

Background: Tissue-sparing approaches to primary treatment and reconstructi ve options provide improved cosmetic outcomes for women with breast cancer. Earlier research has suggested that conservation or restitution of the bre ast might mitigate the negative effects of breast cancer on women's sexual well-being. Few studies, however, have compared psychosocial outcomes of wo men who underwent lumpectomy, mastectomy alone, or mastectomy with reconstr uction. To address some of these issues, we examined women's adaptation to surgery in two large cohorts of breast cancer survivors. Methods: A total o f 1957 breast cancer survivors (1-5 years after diagnosis) from two major m etropolitan areas were assessed in two waves with the use of a self-report questionnaire that included a number of standardized measures of health-rel ated quality of life, body image, and physical and sexual functioning. All P values are two-sided. Results: More than one half (57%) of the women unde rwent lumpectomy, 26% had mastectomy alone, and 17% had mastectomy with rec onstruction. As in earlier studies, women in the mastectomy with reconstruc tion group were younger than those in the lumpectomy or mastectomy-alone gr oups (mean ages = 50.3, 55.9, and 58.9, respectively; P = .0001); they were also more likely to have a partner and to be college educated, affluent, a nd white. Women in both mastectomy groups complained of more physical sympt oms related to their surgeries than women in the lumpectomy group. However, the groups did not differ in emotional, social, or role function. Of inter est, women in the mastectomy with reconstruction group were most likely to report that breast cancer had had a negative impact on their sex lives (45. 4% versus 29.8% for lumpectomy and 41.3% for mastectomy alone; P = .0001). Conclusions: The psychosocial impact of type of primary surgery for breast cancer occurs largely in areas of body image and feelings of attractiveness , with women receiving lumpectomy experiencing the most positive outcome, B eyond the first year after diagnosis, a woman's quality of life is more lik ely influenced by her age or exposure to adjuvant therapy than by her breas t surgery.