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)

Background: The development of various treatment modalities has led to improved prognosis for patients with breast cancer. The diversity of individual values and lifestyles must be considered when deciding on a surgical approach. However, there is a paucity of reports assessing postoperative health-related quality of life (HR-QOL) in these populations from multiple perspectives. Therefore, this study aimed to identify differences in the HR-QOL and the impact on postoperative life for each surgical procedure using patient-reported outcomes in Japanese patients with breast cancer. Patients and Methods: This multi-institutional cross-sectional study included patients with primary breast cancer who underwent total mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR) between August 2013 and July 2021. Data were collected using a questionnaire administered postoperatively between October 2022 and March 2024 to patients who provided consent. BREAST-Q was administered to investigate postoperative HR-QOL and satisfaction. An ad-hoc questionnaire was used to investigate the effects on postoperative life. The BREAST-Q scores and impacts of the three surgical procedures on postoperative life were compared. One-way ANOVA was used to compare the differences in BREAST-Q scores among these groups. Multiple regression analysis was performed to evaluate the relationship between BREAST-Q scores, clinical factors, and social backgrounds. The differences in the impact on postoperative life among these groups were compared using the chi-square test. Results: The questionnaire response rate was 90.2% (577/640). The analysis included 194 patients with MT, 185 with BCS, and 194 with IBR, with mean ages of 58.1, 54.8, and 48.2 years, respectively (p < 0.001). The rates of clinical tumor size (T) ≥ 3 (p < 0.001), clinical nodal stage (N) (p = 0.003), axillary lymph node dissection (p < 0.001), and adjuvant chemotherapy (p < 0.001) were significantly higher in the MT group than in the BCS and IBR groups. Additionally, the frequency of Grade ≥ 3 complications was significantly higher in the IBR group than in the MT and BCS groups (p < 0.001). Of the 198 patients in the IBR group, implant reconstruction was performed in 72.2% of patients, nipple-sparing mastectomy in 39.9%, and one-stage reconstruction in 21.7%. Significant differences were observed in satisfaction with the breasts (SB), psychosocial well-being (PSW), and sexual well-being (SW) using the BREAST-Q among the groups. The SB scores for the MT, BCS, and IBR groups were 46.7, 66.7, and 60.5, respectively (p < 0.001). The PSW scores were 53.3 (MT), 62.9 (BCS), and 61.5 (IBR) (p < 0.001). The SW scores were 31.6 (MT), 44.5 (BCS), and 41.3 (IBR) (p < 0.001). Multiple regression analysis indicated that procedures (SB: MT vs. BCS or IBR, p < 0.001; PSW: MT vs. BCS, p = 0.001; MT vs. IBR, p = 0.027; SW: MT vs. BCS, p = 0.005; MT vs. IBR, p = 0.041) and age (SB, p = 0.006; PSW, p < 0.001; SW, p = 0.016) were significant factors affecting the patients’ quality of life. When comparing the impact on postoperative life between procedures, the proportion of women who did not experience any negative impact on their postoperative lives was the highest in the BCS group (p < 0.001), whereas the proportion of women who developed clothing issues was the highest in the MT group. Conclusions: Surgical procedure and age may have significant impacts on postoperative HR-QOL in women with breast cancer. Women with breast cancer who underwent BCS or IBR had a significantly high aesthetic breast satisfaction and psychosocial and sexual well-being. Postoperative life was significantly less affected in patients who underwent BCS. Citation Format: Hirohito Seki, Maho Kato, Takako Komiya, Nobuko Tamura, Yoshihiro Sowa, Hirotsugu Isaka, Yutaka Nishida, Jyunji Takano, Miho Saiga. Quality of life following total mastectomy, breast-conserving surgery, and immediate breast reconstruction in patients with breast cancer: A multicenter cross-sectional study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS6-08.

To compare psychosocial function outcomes in early breast cancer patients treated with breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR) at 1year after surgery. Early-stage (stage 0-2) breast cancer patients treated with BCS, MA, and IBR at the University Health Network, Toronto, Ontario, Canada between May 1 2015 and July 31 2016 were prospectively enrolled. Their changes in psychosocial functioning from baseline to 12months following surgery were compared by using the BREAST-Q, Hospital Anxiety and Depression Scale, and Impact of Event Scale with ANOVA and linear regression. There were 303 early-stage breast cancer patients: 155 underwent BCS, 78 MA, and 70 IBR. After multivariable regression accounting for age, baseline score, income, education, receipt of chemoradiation or hormonal therapy, ethnicity, cancer stage, and unilateral versus bilateral surgery, breast satisfaction was highest in BCS (72.1, SD 19.6), followed by IBR (60.0, SD 18.0), and MA (49.9, SD 78.0) at 12months, p < 0.001. Immediate breast reconstruction had similar psychosocial well-being (69.9, SD 20.6) compared with BCS (78.5, SD 20.6), p = 0.07. Sexual and chest physical well-being were similar between IBR, BCS, and MA, p > 0.05. Our study found that in a multidisciplinary breast cancer centre where all three breast ablative and reconstruction options are available toearly breast cancer patients, either BCS or IBR can be used to provide patients with a higher degree of satisfaction and psychosocial well-being compared with MA in the long-term.

Post-mastectomy radiation therapy (PMRT) is essential for reducing recurrence in patients with high-risk breast cancer but may negatively impact breast reconstruction outcomes. The impacts of PMRT on breast satisfaction and health-related quality of life (HR-QOL) remain unclear, particularly in Japanese patients. We evaluated the impact of PMRT on breast satisfaction and HR-QOL using BREAST-Q. A multicenter, cross-sectional study was conducted at 10 institutions in Japan. Patients who underwent breast reconstruction with or without PMRT were surveyed using the Japanese version of the BREAST-Q. Endpoints included breast satisfaction and HR-QOL domains (physical, psychosocial, and sexual well-being). Multivariate analysis was performed to identify factors influencing these outcomes. Overall, 1078 patients with primary breast cancer who underwent breast reconstruction were included in this study, with a questionnaire response rate of 77.0% (830/1,078). Data from 830 patients were analyzed (PMRT group: 214, non-PMRT group: 616). The PMRT group had significantly lower breast satisfaction (50.7 vs. 57.5, P < 0.001), physical well-being (70.2 vs. 82.4, P < 0.001), and psychosocial well-being (51.2 vs. 56.4, P < 0.001). There was no significant difference in sexual well-being. PMRT was a predictor of reduced breast satisfaction, physical well-being, and psychosocial well-being. PMRT was associated with decreased breast satisfaction and HR-QOL in patients with reconstructed breasts. Patients should be given comprehensive information regarding the potential impacts of PMRT on breast satisfaction and HR-QOL. Shared decision-making based on realistic preoperative expectations is critical for optimal patient outcomes and satisfaction with treatment modalities.

Background: This study compared the change in pre- and postoperative health-related quality of life (HRQoL) among breast cancer patients undergoing breast-conserving surgery (BCS), total mastectomy no reconstruction (TMNR), and total mastectomy immediate breast reconstruction (MIBR). Patient factors associated with postoperative anxiety and depression were also identified. Methods: This prospective cohort study enrolled breast cancer patients between September 2017 and August 2020. HRQoL changes from preoperative to six months postoperative were compared using patient-reported outcome tools assessing anxiety, depression, pain, perceived health, breast satisfaction, psychosocial, physical, and sexual well-being and analyzed with ANOVA and linear regression. Results: A total of 471 patients completed preoperative and postoperative surveys (BCS: 313, TMNR: 60, MIBR: 98). Postoperative anxiety decreased across all modalities, with MIBR showing the greatest reduction (p = 0.03), though still exhibiting the highest postoperative anxiety (p = 0.05). Depression and perceived health scores showed no significant difference in change across modalities (p = 0.15, p = 0.48). MIBR patients showed the greatest increase in pain (p = 0.05) and the highest postoperative pain scores (p = 0.04). All three modalities showed a clinically significant decline in physical and sexual well-being. TMNR and MIBR had additional reductions in breast satisfaction, with TMNR also showing a decline in psychosocial well-being. Absolute postoperative scores for breast satisfaction, psychosocial, physical, and sexual well-being remained highest in BCS compared to TMNR and MIBR (p < 0.01, for each domain). In multivariable regression analysis, postoperative depression and anxiety scores did not differ between surgical modalities, but younger age was significantly associated with higher postoperative depression, pain and anxiety (p < 0.01), and adjuvant chemotherapy with higher postoperative depression (p < 0.01). Conclusions: BCS may have better overall HRQoL outcomes, specifically in breast satisfaction, psychosocial, physical, and sexual well-being, compared to TMNR and MIBR. Additionally, younger age, rather than surgical modality, was found to be associated with higher postoperative depression, pain, and anxiety scores.

574 Background: Postmastectomy radiotherapy (PMRT) is the standard treatment for improving the prognosis of patients with high-risk breast cancer. Expanded indications for breast reconstruction (BR) will likely increase the number of patients undergoing BR who require PMRT, but combining BR with PMRT raises concerns about complications and aesthetics. Evaluating the impact of PMRT on the health-related quality of life (HR-QOL) in Japanese patients is essential for shared decision-making (SDM). This study assessed differences in postoperative HR-QOL and complications between patients who underwent BR with or without PMRT. Methods: We conducted a multicenter cross-sectional study using a questionnaire survey of patients with primary breast cancer who underwent BR between January 2008 and December 2022 at participating institutions, which was approved by the respective institutional review boards. We used the Japanese version of the BREAST-Q questionnaire and questions on patient backgrounds. Results: We included 1078 patients with primary breast cancer. The questionnaire response rate was 77.0% (830/1078). The non-PMRT and PMRT groups comprised 616 and 214 patients, respectively. The PMRT group had higher rates of axillary lymph node dissection (11.7% vs. 52.4%; P&lt;0.001), adjuvant hormonal therapy (67.2% vs. 90.6%; P&lt;0.001), and perioperative chemotherapy (31.8% vs. 84.0%; P&lt;0.001) than the non-PMRT group. Moreover, the overall complication rate (45.3% vs. 76.2%, P&lt;0.001) and the rates of dermatitis (9.9 vs. 48.1%; P &lt; 0.001), skin necrosis (2.9 vs. 9.8%; P&lt;0.001), breast asymmetry (17.0% vs. 24.3%; P=0.002), capsular contracture (4.9 vs. 16.4%; P&lt;0.001), and lymphedema of the upper limb (1.1% vs. 7.5%; P&lt;0.001) were higher in the PMRT group. Multivariate analysis revealed PMRT as an independent risk factor for dermatitis, skin necrosis, and capsular contracture. In the BREAST-Q assessment, the PMRT group showed lower satisfaction with the breast (55 vs. 49; P&lt;0.001), and with physical (85 vs. 76; P&lt;0.001), psychosocial (55 vs. 49; P&lt;0.001), and sexual well-being (36 vs. 34; P=0.021) than the non-PMRT group. Multiple regression analysis revealed PMRT as an independent factor associated with low BREAST-Q scores for breast satisfaction and physical and psychosocial well-being in patients with BR. Conclusions: This is the first large-scale, multi-institutional study to use patient-reported outcomes to assess the effects of PMRT on HR-QOL in Japanese patients with breast cancer who underwent BR. PMRT was associated with an increased risk of complications and decreased HR-QOL in patients with BR. Of note, these findings do not negate the role of PMRT in patients undergoing BR, but highlight the importance of SDM based on realistic HR-QOL expectations after breast reconstruction surgery with PMRT.

BackgroundPostmastectomy immediate breast reconstruction (IBR) may improve the quality of life (QoL) of breast cancer patients. Guidelines recommend to discuss the option IBR with all patients undergoing mastectomy. However, substantial hospital variation in IBR-rates was previously observed in the Netherlands, influenced by patient, tumour and hospital factors and clinicians’ believes. Information provision about IBR may have a positive effect on receiving IBR and therefore QoL. This study investigated patient-reported QoL of patients treated with mastectomy with and without IBR. MethodsAn online survey, encompassing the validated BREAST-Q questionnaire, was distributed to a representative sample of 1218 breast cancer patients treated with mastectomy. BREAST-Q scores were compared between patients who had undergone mastectomy either with or without IBR. ResultsA total of 445 patients were included for analyses: 281 patients with and 164 without IBR. Patients who had received IBR showed significantly higher BREAST-Q scores on “psychosocial well-being” (75 versus 67, p < 0.001), “sexual well-being” (62 versus 52, p < 0.001) and “physical well-being” (77 versus 74, p = 0.021) compared to patients without IBR. No statistically significant difference was found for “satisfaction with breasts” (64 versus 62, p = 0.21). Similar results were found after multivariate regression analyses, revealing IBR to be an independent factor for a better patient-reported QoL. ConclusionsPatients diagnosed with breast cancer with IBR following mastectomy report a better QoL on important psychosocial, sexual and physical well-being domains. This further supports the recommendation to discuss the option of IBR with all patients with an indication for mastectomy and to enable shared decision-making.

Background: Therapeutic Mammaplasty (TM) is a safe oncoplastic surgical technique aiming to extend the boundaries of traditional breast conserving therapy (BCT) by removing larger breast volumes to reduce and/or lift the breast, without compromising cosmetic or oncological outcomes. Several systematic reviews have emphasised the paucity of Patient Reported Outcome Measures (PROMs) following TM. This study aimed to assess the long-term PROMs following TM performed in our centre over a 17-year period. Methods: Eligible women who underwent TM between 2005 and 2021 were invited to participate by returning the BREAST-Q questionnaire (combination of BCT and Reduction/Mastopexy modules). Surveys were returned by post or online from August to December 2023 (minimum 20-months post TM). Raw responses were transformed using Rasch conversion tables (0=worst;100=best) and descriptive summary statistics generated. Clinical outcome data was collected from digital hospital records/databases and analysed using descriptive summary statistics. Results: Of 246 patients who underwent TM, n=21 (8.5%) subsequently required completion mastectomy, n=15 (6.1%) developed recurrence/metastatic disease and n=22 (8.9%) died. Questionnaires were returned by n=103/188 (53.4%) participants. Only n=4/103 (3.9%) participants were current smokers at the time of surgery; n=10/103 (9.7%) were ex-smokers. Neoadjuvant treatment was given to n=31/103 (30.1%) patients. Most tumours were T1 (n=53/103, 51.5%) or T2 (n=36/103, 34.9%). Only n=19/103 (18.4%) patients had immediate contralateral symmetrizing surgery at the time of TM, but a further n=34/103 (33.0%) had delayed symmetrization surgery. Few women suffered complications (n=15/103, 14.6%), all were minor and there were no peri-operative deaths. Most women received adjuvant radiotherapy (n=95/103, 92.2%); around two thirds received adjuvant endocrine treatment (n=63/103, 61.2%). Overall, patients reported median scores of 69 (IQR 53-83.5) and 70 (IQR 54-86) for satisfaction with breasts for BCT/breast reduction modules respectively. Median wellbeing scores were physical (chest wall) 82 (IQR 66-100), physical (reduction) 72 (IQR 59-82) and psychosocial 77 (IQR 62-93) with lowest scores for sexual wellbeing 59 (IQR 36-79). Comparison was made with published long-term PROMs 12 years following immediate breast reconstruction (IBR) (Johnson et al doi:10.1093/bjs/znad276) using a minimal clinically important difference in mean scores of 4-points for satisfaction with breasts/psychosocial/sexual wellbeing and 3-points for physical wellbeing. TMs performed from 2005 to 2015 (n=40, 8-18 years previously) had significantly better mean long-term satisfaction with breasts scores (TM 72.3(BCT)/74.5(reduction) than all forms of IBR (Implant/expander 54.7; Latissimus Dorsi flap (LD) 59; Abdominal flaps 67.6). Sexual wellbeing scores were also significantly higher for TM (57.4) than for all forms of IBR (Implant/expander 44.7;LD 47.4;Abdominal 51.2). Psychosocial wellbeing scores for TM (78) were higher than both implant/expander 72.2 and LD 73.3 IBR, but comparable to abdominal flap IBR (77.6). TM physical (chest wall) wellbeing scores (80.6) were comparable to implant/expander (82.1) and LD (79.5) IBR, but significantly lower than abdominal flap IBR (87.8). Conclusions: TM has a long-lasting positive impact on quality-of-life following breast cancer treatment. Patient satisfaction with breasts, sexual and psychosocial wellbeing may be significantly higher in the long term than all types of IBR. Physical wellbeing outcomes are comparable to both implant/expander and LD flap IBR but worse than abdominal flaps in our series. With the now growing body of evidence suggesting BCT may also confer a survival advantage over mastectomy, this data suggesting that overall, quality of life is better in the long term, further supports offering oncoplastic BCT preferentially whenever it is oncologically feasible. Citation Format: Katherine Fairhurst, Harriet Cook, Joseph Vane-Daniel, Alison Hunter-Smith, Richard Sutton. LONG TERM PATIENT REPORTED OUTCOMES FOLLOWING THERAPEUTIC MAMMAPLASTY [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-07-03.

Background and Purpose In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. We retrospectively investigated whether IBR after mastectomy influenced the short and long-term outcome of patients receiving NAC. Patients and Methods Between April 2007 and December 2017, 525 breast cancer patients received NAC at our hospital of which 186 patients underwent total mastectomy alone, 55 underwent total mastectomy followed by IBR, and 284 underwent breast conserving surgery (BCS). Patients receiving IBR were compared to patients who did not receive IBR. The NAC regimen was 4 cycles of epirubicin, 5-fluorouracil and cyclophosphamide followed by 4 cycles of docetaxel. Decision making for post mastectomy radiotherapy (PMRT) followed national comprehensive cancer network guidelines. PMRT is not contraindication for patients receiving IBR, however risk such as capsular contracture was informed to patients. Tissue expander was replaced to silicon breast implant within two to three months, and radiotherapy started within 4 to 6 weeks after surgery. In other surgical-procedure, such as direct-to-implant breast reconstruction, BCS or mastectomy alone, radiotherapy started 6-8 weeks later. Post-mastectomy radiation was applied equally with the same selection criteria to both groups. Results Patients in the IBR and BCS groups were on average younger than patients in the mastectomy alone group (p&amp;lt;0.0001). In patients who underwent IBR, 29% of those with autograft and 47% of those with silicone breast implant were received radiotherapy. After a median of 76.4 month, 2 patients (4.2%) in the IBR group, 13 patients (4.5%) in the BCS group and 17 patients (9.1%) showed locoregional recurrences. Five-year locoregional recurrence-free survival was 96.1% in the IBR group, 96.8% in the BCS group and 90.1% in the mastectomy alone group (p= 0.032). Five-year distant disease-free survival was 92.9 % in the IBR group, 93.9% in the BCS group and 85.3 % in the mastectomy alone group (p= 0.0008). Five-year overall survival was 98.0 % in the IBR group, 98.4% in the BCS group and 92.3 % in the mastectomy alone group (p= 0.0004). Multivariate analysis showed that IBR was not associated with worse prognosis. Transverse rectus abdominis muscle flap necrosis was seen in one patient. Any breast implant or tissue expander related complications including infection and capsular contracture were not encountered. Conclusions IBR after total mastectomy can be performed safely and was not associated with worse prognosis in patients receiving NAC and therefore IBR may be the preferred strategy in select cases. Citation Format: Hiroko Nogi, Makiko Kamio, Takashi Kazama, Naoko Shimada, Takayuki Ishigaki, Hisashi Shioya, Yasuo Toriumi, Eijiro Nagasaki, Hiroshi Takeyama. Impact of immediate breast reconstruction after mastectomy on the short and long-term outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-08.

Mastectomy with immediate breast reconstruction (IBR) is a surgical strategy in breast cancer when breast-conserving surgery is not an option. There is a lack of evidence showing an advantage of mastectomy plus IBR over mastectomy alone on health-related quality of life (QoL). A large prospective multicentre survey, STIC-RMI (support of innovative and expensive techniques - immediate breast reconstruction), was undertaken to study the changes in QoL in patients treated by mastectomy with or without IBR. Patients were recruited between 2007 and 2009. European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 instruments were used to assess QoL before operation, and at 6 and 12 months after surgery. A propensity score was used to compare QoL between mastectomy alone and mastectomy plus IBR, with limited bias. A total of 595 patients were included from 22 French academic hospitals, of whom 407 (68·4 per cent) underwent IBR. One-year data were available for 71·1 per cent of patients. Factors associated with IBR were age, histological tumour type, palpable nodes and an attempt at breast-conserving surgery. At inclusion, QoL was significantly better in the IBR group (P < 0·001) and there was no significant change in either group during 1 year compared with baseline. Results for the QLQ-BR23 functional dimension varied according to propensity score quartiles; IBR had no influence in the lowest quartile. In the upper quartiles, QoL increased slightly over the year among patients who had IBR, whereas it decreased among those who had mastectomy alone (P = 0·037). Satisfaction with the cosmetic outcome strongly influenced QoL, especially in upper quartiles (P < 0·001). However, an unsatisfactory outcome after IBR was still considered a better condition than simple mastectomy. The QoL benefit provided by IBR depends on patients' life status at inclusion; young active women with an in situ tumour are more likely to preserve their QoL after IBR.

Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed US Food and Drug Administration regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context. To determine whether fat grafting is associated with patient-reported outcomes (PROs) in patients undergoing breast reconstruction. A longitudinal, multicenter, prospective cohort study was conducted between February 1, 2012, and July 31, 2016, at the 11 sites associated with the Mastectomy Reconstruction Outcomes Consortium Study. Eligible patients included women 18 years or older presenting for breast reconstruction after mastectomy with 2 years or more of follow-up. All primary procedure types (implant based and flap based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by 1 year after starting reconstruction. Fat grafting as an adjunct to breast mound reconstruction. Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q survey, with higher scores on a 0- to 100-point scale indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between those who received and did not receive fat grafting. A total of 2048 women were included (mean [SD] age, 49.4 [10] years), with 165 (8.1%) undergoing fat grafting between years 1 and 2. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference [AMD], -4.74; 95% CI, -8.21 to -1.28; P = .008), psychosocial well-being (AMD, -3.87; 95% CI, -7.33 to -0.40; P = .03), and sexual well-being (AMD, -5.59; 95% CI, -9.70 to -1.47; P = .008), compared with those who did not receive subsequent fat grafting. Following the procedure, the fat-grafted cohort reported similar breast satisfaction (AMD, -0.68; 95% CI, -4.42 to 3.06; P = .72), psychosocial well-being (AMD, -0.59; 95% CI, -3.92 to 2.74; P = .73), and sexual well-being (AMD, -2.94; 95% CI, -7.01 to 1.12; P = .15) 2 years postoperatively. Fat grafting may improve breast satisfaction, psychosocial well-being, and sexual well-being in patients undergoing breast reconstruction.

Background: The experience of application of robotic surgery platform in the management of breast cancer was limited. The preliminary results of robotic surgery (da Vinci) in the management of breast cancer was reported in current study. Methods: Patients with breast cancer received robotic breast surgeries from March 2017 to June 2018 were searched from robotic breast surgery database at Changhua Christian Hospital, Taiwan. Data on clinicopathologic characteristics, type of surgery, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of robotic breast surgery. Patient-reported cosmetic outcome result was also obtained. Results: During the study period, a total of 41 robotic breast surgeries were performed in 35 female breast cancer patients, including 6 patients with bilateral disease. Among these 41 robotic breast procedures, 39 were R-NSM related. Four patients with bilateral R-NSM (two patients with bil. breast cancer, and another two patients received contralateral prophylatic mastectomy (CPM)) without breast reconstruction. The other 31 R-NSM were associated with immediate breast reconstruction (IBR). Two patients received R-NSM and IBR with robotic assisted harvest of latissimus dorsi flap (RAHLDF), and 29 patients received R-NSM and IBR with Gel implant procedures. One patient received robotic assisted quadrantectomy for upper outer located large breast cancer and immediate partial breast reconstruction with RAHLDF. The other patient received endoscopic assisted partial mastectomy for upper inner located multifocal breast cancer and immediate partial breast reconstruction with robotic assisted harvest of omentum flap. Among those patients who received R-NSM, the mean operation time for R-NSM (after set-up of robotic breast surgery system) was 115.6 ± 50 mins, and 70.2 ± 23.2 mins for Gel implant reconstruction. The docking time was quickly dropped from 20 mins to 6-8 mins, and the time needed to complete R-NSM could usually be completed within 100mins after accumulated cases' experience. The mean blood loss was 35 ± 37.2 ml. The positive surgical margin rate for R-NSM was 2.6%(1/39), which was superficial margin involvement, and no further surgery was performed. About 13% patients suffered from transit nipple ischemia change, and no total nipple areolar complex necrosis case was observed. Among those 3 patients who received RAHLDF, it took about 267 mins, 97 mins, and 90 mins to complete the 1st, 2nd, and 3rd RAHLDF, separately. All of them were event free, except seroma formation over the back, which relived after repeat aspiration. No local recurrence, or mortality was found among these 35 patients during mean 8.9 ± 4.2 months follow-up. The patient-reported survey shows that 97%(32/33) of the patients who received robotic breast surgery with breast reconstruction satisfied the cosmetic outcome. Conclusion: From our preliminary experience, robotic breast surgery is a feasible and safe option for some selected indications of breast cancer patients. R-NSM and IBR with Gel implant or RAHLDF were the most frequent performed operations. Bilateral R-NSM could be safely performed in bilateral breast cancer patients or unilateral breast cancer patients combined with CPM. Citation Format: Lai H-W, Chen S-T, Chen D-R, Kuo S-J, Lin S-L. Application of robotic surgery (da Vinci) in the management of breast cancer- Preliminary results and experience sharing [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-25.

Introduction: Although SSO/ASTRO consensus margin guidelines have led to decrease rate of re-excision, some women require additional surgery. Re-excision surgery may cause psychosocial stress and impact cosmetic outcomes and breast satisfaction. The purpose of this study was to assess patient-reported outcomes using the BREAST-Q breast satisfaction, psychosocial wellbeing, and sexual wellbeing subscales for women with breast cancer following index breast-conserving surgery (BCS). Methods: Women with stage 0 to 3 breast cancer undergoing BCS who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. The BREAST-Q breast conserving therapy module was used to assess outcomes between women with 1 BCS and those with ≥1 re-excision surgery (R-BCS). Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time. Results: Our study group was initially composed of 2570 women that was narrowed to 2549 women after excluding 21 who ultimately underwent mastectomy; 1982 (78%) had 1 BCS and 567 (22%) had ≥1 R-BCS. The median age of the cohort was 57 years (range 26-97). Women with 1 BCS were more likely to be older (p&amp;lt;0.001), have a higher BMI (p=0.01), present with invasive carcinoma (p=0.03), have unifocal disease (p&amp;lt;0.001), undergo surgery post-release of SSO Invasive Guidelines (p&amp;lt;0.001), receive endocrine therapy (p=0.006), and less likely to receive radiation therapy (p=0.02) compared to those with ≥1 R-BCS. At 2-years post-operative, women with ≥1 R-BCS compared to 1 BCS were noted to have lower average breast satisfaction and sexual well-being scores (76.0 vs. 71.8 [p=0.03] and 70.2 vs. 64.0 [p=0.01], respectively). No difference in psychosocial well-being scores existed for up to 5 years of post-operative follow-up. Multivariable linear regression confirmed that undergoing ≥1. R-BCS is a risk factor for decreased breast satisfaction and sexual well-being at 2 years postoperative. On multivariable analysis, re-excision was found to be associated with lower breast satisfaction and sexual well-being scores. (p=0.01 and p=0.02, respectively), while it was not associated with a change in psychosocial wellbeing score (p=0.07). Factors such as Race, BMI, and marital status were not associated with any difference across all subscales (all p&amp;gt;0.1). Chemotherapy and radiotherapy were associated with lower scores across all subscales (Table). Younger age was associated with lower psychosocial and sexual well-being scores (both p&amp;lt;0.001), and endocrine therapy was associated with a lower sexual well-being score (p=0.01). Conclusions: Psychosocial well-being in women with 1 BCS for breast cancer were largely comparable over time to those who underwent ≥1 R-BCS. At 2 years post-operative, women with 1-BCS had lower breast satisfaction and sexual well-being, but this difference did not remain at later time periods. These findings may help in counseling women who are concerned of satisfaction and quality of life outcomes with BCS if breast re-excision was necessary. Multivariable analysis of BREAST-Q Subscale scoresEstimateStandard Errorp valueBreast SatisfactionAge at surgery-0.0690.0480.147BMI-0.1380.0810.088Chemotherapy-2.5421.0260.015Adjuvant radiation-3.4371.5830.031Hormonal therapy-0.6511.1700.119≥1 R-BCS vs. 1 BCS-2.5420.8840.008Psychosocial well-beingAge at surgery0.1980.043&amp;lt;0.001BMI-0.079-0.0790.287 Chemotherapy-3.2090.9330.001Adjuvant radiation-4.5091.4600.004Hormonal therapy0.2081.0740.528≥1 R-BCS vs. 1 BCS-1.4450.7930.059Sexual well-beingAge at surgery0.2700.072&amp;lt;0.001BMI-0.1140.1180.337Chemotherapy-4.7131.428&amp;lt;0.001Adjuvant radiation-7.6292.493&amp;lt;0.001Hormonal therapy-1.1801.7080.008≥1 R-BCS vs. 1 BCS-2.9661.2190.015 Citation Format: Regina Matar, Meghan Flanagan, Sarah Fuzesi, Kathyrn Haglich, Shen Yin, Varadan Sevilimedu, Jonas Nelson, Mary L. Gemignani. The impact of breast conserving surgery re-excision on patient-reported outcomes using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-02.

This study aimed to explore (1) the levels of quality of life (psychosocial, physical and sexual well-being) and breast satisfaction in breast cancer patients (BCP) after immediate reconstruction (IR), considering surgery reason and surgical technique, and (2) the explanatory and predictive capacity of psychosocial well-being on breast satisfaction, and of both on sexual well-being. This prospective study included 36 BCP who underwent IR between June 2006 and December 2014. Highest levels of quality of life were found in psychosocial well-being and sexual well-being, with no statistically significant differences by surgery reason or surgical technique in any quality of life indicator or breast satisfaction. Psychosocial, physical well-being and breast satisfaction explained 56.16% of the variance in sexual well-being, where 44.67% was attributed to psychosocial well-being. In addition, breast satisfaction statistically significantly mediated the relationship between psychosocial and sexual well-being, independently of physical well-being. Our findings highlight the importance of IR in reducing psychological morbidity and preserving the quality of life and breast satisfaction. Furthermore, this research indicated that psychosocial well-being should be considered a useful personal resource for improving the sexual well-being of BCP undergoing IR both through its direct effect and the mediated effect of breast satisfaction.

Effect of Breast Surgery on Quality of Life in BRCA Mutation Carriers With Invasive Breast Cancer: A CANTO Database Study.

Introduction: Despite recommendations by breast cancer guidelines, that immediate breast reconstruction (IBR) should be offered to all breast cancer patients considered for mastectomy national IBR rates have been reported as low as 12% in Australia. We report our oncoplastic breast cancer unit experience on acceptance of IBR, where it is routinely offered for all the medical fit breast cancer patients. Methods: We retrospectively reviewed, prospectively collected data on IBR by 3 oncoplastic breast cancer surgeons from 1st of September 2014 to 31st of March 2016.Patients were considered to be unfit for IBR if they were American Society of Anasthesiologist (ASA) Score 4 or 5, have unstable psychiatric illness, inflammatory breast cancer or high metastatic cancer burden. All the patients who were fit for IBR were offered both prosthetic and autologous IBR options. Results: 137 patients underwent mastectomy operation, of whom 27 were considered unfit for IBR. Of the remaining 110 patients, 84 (76%) accepted IBR. Of the patients who had IBR 64 (76%) had single stage prosthetic, 15 (18%) two stage prosthetic and 5 (6%) autologous reconstructions. Those who accepted IBR were younger compared to those who didn't have IBR (median age: 47 yrs vs. 67 yrs, p&amp;lt;0.001), and were more likely to be in current relationship (78.57% vs. 61.54%, p=0.06). All the three surgeons had high IBR acceptance rates (70.45%, 71.43%, 84.44%) and patient insurance status did not influence IBR acceptance rate (public 57% vs. private 65%, p=0.47). The majority of patients (25 of 26) who did not accept IBR stated that breast reconstruction was not important for their body image. Conclusion: Our recent data shows, in Australia, when routinely offered to breast cancer patients who are fit for reconstructive surgery by oncoplastic breast cancer surgeons, IBR is highly accepted. Younger patients and those who are in current relationship, were more likely to accept IBR, whereas, individual perception of insignificance of breast reconstruction for the body image was the main determinant of not accepting IBR. Citation Format: Cheung DSM, Trinh L, Edirimanne S, Eslick G. Immediate breast reconstruction is highly accepted by breast cancer patients undergoing mastectomy when routinely offered- Recent experience of an Australian tertiary oncoplastic breast unit [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-08.