"V体育ios版" Breast satisfaction and health-related quality of life following total mastectomy, breast-conserving surgery, or immediate breast reconstruction in Japanese patients with breast cancer: multicentre cross-sectional controlled study (Reborn)

Introduction

Advances in treatment have considerably improved the prognosis of patients with early-stage breast cancer, leading to a paradigm shift in surgical management. Historically, mastectomy (MT) was the only surgical option; however, there has been a gradual increase in the adoption of breast-conserving surgery (BCS) combined with radiation therapy as standard of care1,2. In recent years, advances in imaging technology have facilitated the detection of extensive intraductal lesions and multicentric, multifocal disease, whereas improvements in immediate breast reconstruction (IBR) techniques have contributed to a growing trend towards the use of MT3. Moreover, contemporary breast cancer surgery requires a balanced approach that achieves both oncological safety and optimal aesthetic functional outcomes4 VSports手机版.

Previous study have demonstrated improved overall and breast cancer-specific survival in patients undergoing BCS with radiation compared with those undergoing MT alone5 . However, concerns have been raised regarding reductions in breast volume that lead to breast asymmetry and the potential deterioration of health-related quality of life (HR-QoL) due to radiation therapy6. Although total MT may induce psychological distress because of complete breast loss, it is a therapeutic approach that eliminates the need for radiation therapy associated with BCS7. Furthermore, MT avoids the increased risk of complications and multiple surgical procedures often required for breast reconstruction8. IBR has become a standard approach for women undergoing MT who wish to maintain their breast shape V体育安卓版. The increasing adoption of IBR is attributed to its superior cosmetic outcomes and positive effect on quality of life9, with low local recurrence rates and favourable prognosis after local recurrence10,11. Furthermore, advances in minimally invasive surgical techniques for IBR and predictive models for assessing the risk of residual tumour have improved the oncological safety of IBR and aesthetic outcomes12–14.

In recent years, shared decision-making between patients and healthcare providers has been increasingly recognized as a crucial component in determining treatment strategies15. The decision-making process for breast cancer surgery requires information on both treatment-related and HR-QoL outcomes, including physical, psychological, and sexual well-being; changes in body image; and impact on daily life after the procedure16. Although traditional outcome evaluations have predominantly relied on subjective assessments by healthcare providers or medical indicators, understanding patients’ perception, evaluation, and values regarding postoperative results is essential for determining appropriate treatment strategies. Patient-reported outcomes (PROs), which reflect HR-QoL and patient satisfaction, are crucial for assessing breast surgery outcomes17 V体育ios版. The BREAST-Q is a PRO measure designed to assess the impact of breast surgery on patients’ HR-QoL and satisfaction levels. Because of its high reliability and validity, BREAST-Q has been widely adopted globally18.

There are numerous comparative studies of postoperative breast satisfaction and HR-QoL between groups undergoing different surgical procedures^19,20. However, comprehensive studies on differences in satisfaction and HR-QoL among the three surgical approaches (MT, BCS, and IBR) are limited²¹. Furthermore, HR-QoL may be influenced by racial and cultural factors²². The aim of the present multicentre cross-sectional study was to elucidate the differences in breast satisfaction and HR-QoL using PROs among Japanese patients with breast cancer who underwent MT, BCS, or IBR.

Methods

"VSports" Results

Discussion

Although the expanded range of treatment options has enabled more flexible approaches, determining the optimal surgical procedure for each patient remains a critical challenge because each procedure has its own advantages and disadvantages. In this study, breast aesthetic satisfaction was significantly higher in the BCS group than in the MT and IBR groups, whereas psychosocial and sexual well-being were significantly better in the IBR and BCS groups than in the MT group. The type of surgical procedure was the most influential factor on BREAST-Q scores. However, the findings of this study do not definitively establish the superiority of any one surgical approach over the others, which highlights the importance of comprehensive preoperative counselling to ensure that patients receive detailed information on potential HR-QoL differences. The findings of this study may contribute to more appropriate decision-making by patients with breast cancer.

The finding that breast satisfaction was significantly lower in the MT group than in the BCS and IBR groups is consistent with findings reported previously^21,28. In addition, breast satisfaction in the present study was significantly higher in the BCS group than in the IBR group, which contrasts with the findings reported by Howes et al.²¹. Several factors could explain this discrepancy, such as the time interval between surgery and survey responses, which is known to influence breast satisfaction and HR-QoL in patients who underwent BCS^29–31. In the present study, the median time from surgery to survey completion was approximately 56 months in both groups. In contrast, Howes et al.²¹ reported that the median postoperative period was significantly shorter in the BCS group (29 months) than in the IBR group (48 months), which may have influenced their results.

In addition, breast asymmetry may have played a role in breast satisfaction scores in the BCS group, with Howes et al.²¹ reporting that 75.3% of women who underwent BCS perceived some degree of breast asymmetry and that 15.5% of these women considered the asymmetry sufficiently problematic to consider surgical correction. Cochrane et al.³² reported that the proportion of excised breast volume was a critical determinant of cosmetic outcomes and patient satisfaction after BCS. Oncoplastic BCS results in superior aesthetic outcomes and higher patient satisfaction than the standard BCS³³. Although it is unclear how many patients in the BCS group in the present study underwent oncoplastic BCS, this technique has been increasingly adopted in Japan since the early 2010s, potentially contributing to the higher breast satisfaction observed in the BCS group³⁴.

Differences in reconstruction methods may have also influenced the results. In a previous study²¹, approximately 60% of patients underwent autologous tissue reconstruction, whereas in the present study this proportion was approximately 30%. Patients who undergo autologous tissue reconstruction report higher satisfaction with their reconstructed breasts than those who undergo implant-based reconstruction^35–37, with these findings consistent across multiple studies using the BREAST-Q. The relatively low proportion of patients undergoing autologous reconstruction in the present study may have contributed to the lower breast satisfaction observed in the IBR group. Studies comparing BCS with MT and reconstruction have shown that BCS leads to higher patient satisfaction and better body image outcomes^38,39. Patients who undergo BCS have been reported to have significantly higher breast satisfaction scores than those who undergo MT with implant reconstruction^38,39. BCS is also associated with better HR-QoL scores across various subscales³⁸. Although one study⁴⁰ found no significant difference in body image between the BCS and reconstruction groups, patients undergoing BCS reported higher satisfaction with surgery. Notably, patients with free-flap reconstruction had satisfaction scores comparable to those who underwent BCS, whereas those with implant-based reconstructions scored lower³⁹. These findings suggest that BCS may be preferable when oncologically appropriate because it offers better PROs. On the basis of the results of the present study alone, it cannot be definitively concluded that BCS results in higher breast satisfaction than IBR. However, it is unequivocal that breast satisfaction in both the BCS and IBR groups is superior to that in the MT group.

Howes et al.²¹ reported that patients who underwent BCS experienced a greater decline in physical well-being than those who underwent MT or IBR; however, in the present study, there was no significant difference in physical well-being among the three groups. This discrepancy may again be attributed to the relatively shorter time interval between surgery and survey completion in the BCS group than in the other two groups in the previous study²¹. One possible factor contributing to the decline in physical well-being after BCS is the impact of postoperative radiotherapy. However, patients undergoing BCS who receive postoperative radiotherapy generally experience only mild and temporary impairments⁴¹. Furthermore, studies examining the effects of radiotherapy on the HR-QoL of patients with breast cancer undergoing BCS suggest that the long-term effects are minimal^41,42. Zehra et al.²⁸ reported that the BCS and IBR groups had better outcomes in terms of physical well-being than the MT alone group. In addition, Warm et al.⁴³ found no significant differences in the well-being or quality of life of patients based on the type of surgery performed. These conflicting reports suggest that the effect of surgical approaches on physical well-being varies among individuals and may change over time. This underscores the importance of personalized treatment decisions and the need for long-term follow-up to comprehensively assess patient outcomes.

In this study, psychosocial well-being was significantly higher in the BCS and IBR groups than in the MT group. Howes et al.²¹ reported no differences among the three surgical approaches and Zehra et al.²⁸ found that breast reconstruction yielded better outcomes in terms of body image than MT alone. Similarly, Vohra et al.⁴⁴ observed that patients who underwent MT with reconstruction had higher psychosocial well-being scores than those who underwent MT alone. In addition, Moyer et al.⁴⁵ reported that BCS conferred slight advantages in terms of psychological well-being, marital intimacy, social adaptation, body image, and cancer-related concerns. Together, these findings suggest that both breast reconstruction and BCS may offer psychosocial benefits over MT alone.

Although satisfaction with breast aesthetics and HR-QoL may be influenced by various factors beyond surgery, the findings of the present study confirmed that the type of surgical procedure was the most influential factor. It has been reported that surgery type is an independent predictor of breast satisfaction and psychosocial well-being⁴⁶. Although age was also identified as a factor contributing to breast satisfaction and sexual well-being in the present study, the age distribution in the IBR group may have influenced these findings. Higher levels of physical activity may positively influence the psychosocial well-being of patients⁴⁷ .

In the present study, the potential presence of selection and recall biases is a concern. However, the findings hold academic significance as the first multicentre cross-sectional study in Japan, conducted within this unique social context, characterized by racial homogeneity among patients and a relatively uniform healthcare system. In the future, prospective studies evaluating breast satisfaction and HR-QoL in patients with breast cancer, as well as research on decision-making processes, are warranted.

Supplementary Material

Funding

This study was supported by a grant from the Scientific Committee of Japanese Oncoplastic Breast Surgery Society (grant number: jopbs2021-02).

Author contributions (VSports注册入口)

Hirohito Seki (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing—original draft), Takako Komiya (Conceptualization, Investigation, Writing—review & editing), Yoshihiro Sowa (Conceptualization, Investigation, Writing—review & editing), Maho Kato (Conceptualization, Investigation, Writing—review & editing), Yutaka Nishida (Formal analysis, Methodology, Writing—review & editing), Hirotsugu Isaka (Investigation), Junji Takano (Data curation), Miho Saiga (Conceptualization, Funding acquisition, Investigation, Methodology, Resources, Supervision, Writing—review & editing), and Shigeru Imoto (Writing—review & editing)

Disclosure

The authors declare no conflict of interest.

"V体育官网" Supplementary material

Supplementary material is available at BJS Open  online.

VSports - Data availability

The data sets are not publicly available due to restrictions imposed under the license for the present study, but are available from the corresponding author upon reasonable request.