Effect of cosmetic outcome on quality of life after breast cancer surgery

https://doi.org/10.1016/j.ejso.2014.12.002Get rights and content

Abstract

Purpose

Studies regarding the effects of aesthetic outcomes after breast cancer surgery on quality of life (QoL) have yielded inconsistent results. This study analyzed the aesthetic outcomes and QoL of women who underwent breast conserving surgery (BCS) or total mastectomy with immediate reconstruction (TMIR) using objective and validated methods.

Patients and methods

QoL questionnaires (EORTC QLQ-C30, BR23, and HADs) were administered at least 1 year after surgery and adjuvant therapy to 485 patients who underwent BCS, 46 who underwent TMIR, and 87 who underwent total mastectomy (TM) without reconstruction. Aesthetic results were evaluated using BCCT.core software and by a panel of physicians. Patients' body image perception was assessed using the body image scale (BIS).

Results

QoL outcomes, including for social and role functioning, fatigue, pain, body image, and arm symptoms, were significantly better in the BCS and TMIR groups than in the TM group (p<0.05 each). BIS was significantly better in the BCS than in the TM or TMIR group (p<0.001 each). In the BCS and TMIR groups, general QoL factors were not significantly associated with objective cosmetic outcomes, except for body image in the QLQ-BR23. In contrast, patients with poorer BIS score reported lower QoL in almost all items of the QLQ-C30, BR23, and HADS (p<0.05 each).

Conclusion

In conclusion, BCS and TMIR enhanced QoL compared with TM. Among BCS and TMIR patients, objectively measured cosmetic results did not affect general QoL. Self-perception of body image seems to be more important for QoL after breast cancer surgery.

Introduction

Treatment for breast cancer frequently results in marked changes to the physical appearance of patients. The overall safety of breast conserving surgery (BCS) and reconstruction surgery, as well as improvements in long term outcomes of breast cancer treatment, have enhanced concerns about esthetic results. However, despite efforts to preserve their breasts for cosmetic reasons, a substantial percentage of patients are not satisfied with the esthetic result of surgery. For example, one study reported that 28.3% of patients who underwent BCS were dissatisfied with the cosmetic results.1 Moreover, unlike oncologic outcomes, there are no standard and objective methods for evaluating esthetic outcomes. An objective measure of assessing breast cosmetic results after BCS or reconstruction is needed to improve surgical strategies and to identify factors that affect esthetic outcomes.

The extent to which cosmetic results affect the quality of life (QoL) of breast cancer patients remains unclear. QoL is an important endpoint of breast cancer treatment, and the effects of various interventions on the QoL of these patients are of major interest. However, studies to date of the effects of esthetic outcomes on postoperative QoL have yielded inconsistent results.2, 3, 4, 5, 6 Evaluation using standardized and validated methods may justify efforts to improve cosmetic outcomes of breast cancer surgery, as well as being essential for patients to make an informed choice of surgical options.

The aim of this study was to investigate patient QoL after breast cancer surgery and to correlate these QoL results with subjectively and objectively measured breast cosmesis. We therefore analyzed and compared esthetic results and patient QoL in women who underwent BCS and those who underwent total mastectomy followed by immediate reconstruction (TMIR).

Section snippets

Patients

This study was approved by the Institutional Review Board (IRB) of Seoul National University Hospital (IRB No. 1206-120-416). We surveyed all women who underwent BCS or TMIR at Seoul University Hospital by a single surgeon (Han W) between January 2007 and September 2011. Women were included if they had: 1) primary, unilateral, histologically proven invasive or in situ breast cancer; 2) clear resection margins at final surgery; 3) no evidence of disease recurrence or metastasis during the

Patient characteristics

The study included 485 women who underwent BCS and 46 who underwent TMIR between January 2007 and September 2011. 86 patients who underwent TM without reconstruction were selected as a control group. Patient characteristics are presented in Table 1. Patients in the TMIR group were significantly younger and had significantly lower BMI than patients in the BCS and TM groups (p = 0.001 each). Cancer stage, however, was similar in the three groups, as were the proportions of patients who received

Discussion

This study attempted to clarify the relationships among esthetic results and patient QoL in women who have undergone breast cancer surgery. The impact of objectively measured breast cosmetic results and patient reported body image on QoL was analyzed a median 2.1 years after BCS or TMIR. We found that breast symmetry, measured objectively by BCCT.core software and panel judgment, did not correlate with patients' general QoL. In contrast, patient self-reported BIS was significantly associated

Acknowledgments

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea Government (MSIP) (No. 2012M3A9B2028834, No. 2013005540).

References (28)

Cited by (131)

  • Long-term quality of life and aesthetic outcomes after breast conserving surgery in patients with breast cancer

    2022, European Journal of Surgical Oncology
    Citation Excerpt :

    Chemotherapy has proven to be associated with lower QoL, probably because of side effects and long-term physical effects [28,29]. Some previous studies have shown no influence of hormonal therapy on aesthetic outcome, however others have shown it may have negative impact [16,18,30,31]. Although asymmetry is not associated with aesthetic outcome in this study, other studies that include breast-specific factors in their analysis towards aesthetic outcomes have also been negatively influenced by asymmetry and scar appearances [15,18,22].

  • Special Considerations in Patients with Early-Stage Breast Cancer and Survivors

    2022, Obstetrics and Gynecology Clinics of North America
View all citing articles on Scopus
h

Both authors contributed equally.

View full text