Abstract
PURPOSE: Sexual well-being is the third most common concern reported by breast cancer patients, but often overlooked in postoperative survivorship. This study aims to understand sexual well-being in breast cancer patients, including the trend, associated factors, and interventions. METHODS: We analyzed patients who underwent post-mastectomy breast reconstruction or lumpectomy and completed the BREAST-Q sexual well-being module between 2010 and 2021. We compared sexual well-being in reconstruction and lumpectomy patients over time, delineated associated factors, and evaluated the incidence and impact of sexual medicine consultation. RESULTS: 16,061 lumpectomy and breast reconstruction patients were included. Reconstruction patients had consistently lower sexual well-being than lumpectomy patients, from preoperative to 5-year follow-up (p<0.001). In reconstruction, factors associated with lower sexual well-being at 1-year included separated/single marital status, higher BMI, postmenopausal status, and psychiatric disorders (p<0.05). Patients with more advanced cancer, axillary dissection, and skin-sparing mastectomy (vs. nipple-sparing) had lower sexual well-being. Overall, 5.5% of reconstruction patients received a sexual medicine consultation. Patients who received the consultation were younger, from lower income bracket, underwent lymph node dissection, and had lower preoperative scores than those without consultation (p<0.05). BREAST-Q scores improved from 36.4±21.5 to 41.3±19.5 (p=0.004) following intervention. CONCLUSION: Decreased sexual well-being is imperative to consider in breast reconstruction patients, particularly among those who are separated/single or have psychiatric disorders and advanced cancer. Only a small fraction of patients receives sexual medicine consultation, yet such intervention improves patients’ sexual health. Providers should assess sexual well-being in breast reconstruction and refer for sexual medicine consultations when appropriate.
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