Regret and Quality of Life after Mastectomy with or without Reconstruction

ABSTRACT BACKGROUND Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and quality of life (QOL) of women so treated, with or without breast reconstruction (BR). PATIENTS AND METHODS 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 EORTC QLQ C30 items was presented either by email, letter or telephone interview. RESULTS 328 patients participated, while 140 declined the invitation or were unavailable (30%). Median age was 63 years (30-93). Stage I or II of disease was recorded in 73% of patients. Immediate BR was performed in 168/328 patients (51%). Of the remaining patients only 7/160 (4%) proceeded to delayed BR. Younger women had significantly worse Emotional Functioning (EF) and Social Functioning (SF) scores (p CONCLUSIONS Younger patients with breast cancer report a worse impact on their EF and SF 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. A pre-operative plastic surgeon consultation improves the rate of immediate BR, while delayed reconstruction is rarely adopted. Some 20% of patients are disappointed or regret their decision regarding BR. We need to improve our management in consideration of these findings.