Breast Satisfaction Research Articles

Three-Pedicle Reduction Mammaplasty Technique in the Treatment of Greater Breast Hypertrophy Patients With or Without Breast Cancer: Surgical and Patient-reported outcomes.

Reduction mammoplasty (RM) is an important procedure in the management of symptomatic greater breast hypertrophy with or without early-stage breast cancer. We aim to introduce a new procedure: the three-pedicle reduction mammaplasty technique. A prospectively maintained database was reviewed, and two prospectively registered clinical studies were included of all breast hypertrophy patients with or without breast cancer who underwent three-pedicle RM with inverted T incision at West China Hospital or the Fourth People's Hospital of Sichuan Province from 2018 to 2022. Patient demographics, patient-reported cosmetic results, quality of life (QoL), surgical outcomes and complications were assessed. During a median period of 22.5 months, 101 reduction mammaplasties were performed (Mage= 35.80; MBMI= 27.05). Mean reduction weight was 880.9 g ranging from 423-1630 g per breast. The nipple-to-sternal notch distance (N-SN) at post-operation was significantly shorter than preoperatively (left, 34.51 cm; right, 34.69 cm). Major complications and minor complications were 1.9% (1/52 patients) and 13.5% (7/52 patients), respectively. Multivariate logistic regression analyses showed that BMI > 30 was independent risk factors for a complication. Except for sexual and physical well-being at 1-month post-operation, patients gave a higher score on the BREAST-Q (breast satisfaction, physical well-being, psychosocial well-being) after the operation than before the operation (P<0.001). The three-pedicle RM technique was demonstrated to be an effective and safe RM procedure for moderate to severe breast hypertrophy patients with or without breast cancer, with the advantages of removing the lesions, reducing hypertrophic breasts and accomplishing mammoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Satisfacción y calidad de vida de las pacientes mastectomizadas por cáncer de mama según la reconstrucción mamaria

Introduction and objectiveMastectomy and breast reconstruction are procedures that are part of the multidisciplinary management of breast cancer. Currently, the BREAST-Q questionnaire is available, which allows objective and numerical determination of the quality of life and satisfaction of patients who have undergone breast surgery. Studies have evaluated the repercussions of post-mastectomy breast reconstruction with inconsistent results, likewise there are no similar investigations in the Peruvian population. The objective of the present study is to determine and compare the level of satisfaction and quality of life in patients with breast cancer who underwent mastectomy with and without breast reconstruction. Material and methodsObservational, analytical cross-sectional study carried out in patients with mastectomies for breast cancer with and without breast reconstruction at the Aliada Oncology Center, Lima-Peru. 46 patients operated between the years 2016-2021 were included. The quality of life and satisfaction of the patients was evaluated using the BREAST-Q questionnaire. ResultsSignificant differences were obtained in the breast satisfaction and sexual well-being scales when comparing mastectomy patients with and without breast reconstruction, where the group with reconstruction reflected a better result in satisfaction and quality of life. No significant results were obtained in the scales of attention of the medical team, adverse events of radiation and according to the type of breast reconstruction. ConclusionsThe BREAST-Q instrument showed that patients undergoing breast reconstruction obtained better results on the satisfaction and quality of life scales compared to patients without breast reconstruction.

Breast satisfaction in adult woman treated with Grisotti flap reconstruction for centrally located breast cancer, using BREAST-Q score

Breast satisfaction in adult woman treated with Grisotti flap reconstruction for centrally located breast cancer, using BREAST-Q score

The Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction.

This study aimed to evaluate how enhanced recovery (ER) protocols and same-day discharge (SDD) influences patients' postoperative quality of life (QOL). Patients who underwent mastectomy with implant-based breast reconstruction from 2008 to 2020 were identified in a prospective database. The study assessed QOL with BREAST-Q and Was It Worth It? (WIWI) questionnaires. Responses were compared between the ER and pre-ER groups and between the SDD and hospital stay (HS) groups using one-way analysis of variance (ANOVA) and chi-square tests. The inclusion criteria were met by 568 patients, with a 43% response rate, and 217 patients were included for analysis. Chest physical well-being was lower for the ER cohort, but postoperative breast satisfaction was higher. Psychosocial status, sexual well-being, and satisfaction with information given did not differ significantly between the ER group and the pre-ER or SDD group. In the compared groups, QOL did not differ significantly. Enhanced recovery with SDD after mastectomy using implant-based reconstruction did not have an adverse impact on patient postoperative QOL.

Abstract B020: Does surgical procedure influence psychosocial outcomes after treatment in women with ductal carcinoma in situ?

Abstract Objective: Rates of bilateral mastectomy are increasing in women with ductal carcinoma in situ (DCIS). We aim to characterize the trajectory of psychosocial outcomes after surgery in women with DCIS. Methods: We have been prospectively collecting psychosocial data on women receiving surgery for stage 0-III breast cancer at University Health Network in Toronto, Ontario, Canada since 2009. We queried our prospective database to identify all women receiving surgery for DCIS between May 2009 and January 2020. Women completed validated psychosocial questionnaires (e.g. BREAST-Q, Impact of Event Scale, Hospital Anxiety &amp; Depression Scale) pre-operatively, and at 6 and 12 months following surgery. We analyzed the change in psychosocial scores between three surgical procedures (breast-conserving therapy, unilateral mastectomy and bilateral mastectomy) using linear mixed models, controlling for age and sociodemographic factors (e.g. ethnicity, education level, income and marital status). P values &amp;lt; .05 were significant. Results: 89 women with DCIS were identified, with a mean age of 52.4 ± 10.3 years. By surgical procedure, 7 women underwent breast-conserving therapy (8%), 46 underwent unilateral mastectomy (52%) and 36 underwent bilateral mastectomy (40%). Breast satisfaction (-8, P = .03) and sexual well-being (-10, P = .02) scores decreased over time but was not influenced by surgical procedure. Younger women had worse psychosocial well-being scores (-0.5/year, P = .02), with no impact of surgical procedure. There was a significant interaction between surgical procedure and time for chest physical well-being scores (P = .04); women having breast-conserving therapy had better chest physical well-being scores compared with both unilateral and bilateral mastectomy (with no difference between mastectomy groups). Unemployed women had worse chest physical well-being scores (-9, P = .04). There was a significant interaction between procedure and time for distress scores (P = .02); women having unilateral or bilateral mastectomy had higher distress scores before surgery but at 12 months, there was no difference between surgical procedures. Women with a higher annual income (≥80,000$) had higher breast satisfaction (+10, P = .03), psychosocial well-being (+14, P = .004), and sexual well-being (+12, P = .02), and lower distress (-12, P = .004 ) scores than women earning less than 80,000$ per year. There was a significant interaction (P = .01) between procedure and time for anxiety scores; while all surgical groups had mild anxiety scores at baseline, the anxiety scores for both unilateral and bilateral mastectomy groups improved to normal range over time while scores for women having breast-conserving therapy remained mild. Conclusions: Surgical procedure influences chest physical well-being, distress and anxiety scores in women with DCIS. Our data may help inform surgical decision-making for women with DCIS, and highlight a need for identifying women with high distress at diagnosis who may benefit from targeted psychosocial support. Citation Format: David W. Lim, Helene Retrouvey, Isabel Kerrebijn, Benita Hosseini, Anne C. O'Neill, Tulin D. Cil, Toni Zhong, Stefan O.P. Hofer, David R. McCready, Kelly A. Metcalfe. Does surgical procedure influence psychosocial outcomes after treatment in women with ductal carcinoma in situ? [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr B020.

Study on short-term cosmetic effects and quality of life after breast cancer modified radical mastectomy combined with one-stage prosthesis implantation.

This study investigated the reconstruction effect of skin-preserving breast cancer modified radical mastectomy combined with one-stage breast prosthesis implantation in female patients to analyze relevant factors and observe the effect of prosthesis reconstruction on short-term breast satisfaction, psycho-social functions, and quality of life (QOL) in patients with breast cancer after the operation. Patients were divided into two groups based on the reconstruction effect (an excellent effect group and a good and general effect group). Patients' short-term cosmetic effect on the breast after breast cancer modified radical mastectomy combined with one-stage breast prosthesis implantation was prospectively followed up to analyze influencing factors. At post-operative 6 months, the breast satisfaction dimension, psycho-social dimension, upper limb breast health dimension, and surgical satisfaction dimension in the prosthesis reconstruction module in the BREAST-Q scale were used for follow-up evaluation. The excellent rate of prosthesis reconstruction was 91.3%. A significant correlation was observed among the reconstruction effect, implant volume, and number of children born by the patient (P < 0.05). The correlation with age, BMI (body mass index), operation time, nipple and areola retention, operation method, and incision was not statistically significant (P > 0.05). At post-operative 6 months, the Breast-Q score was significantly different in the overall breast satisfaction dimension and outcome satisfaction dimension between the two groups (P < 0.05). Breast cancer modified radical mastectomy combined with one-stage breast prosthesis implantation can not only fulfill patients' physical aesthetic needs but also positively affect their psychosocial behavior to improve post-operative QOL.

Elective Replacement of Shaped Textured Implants with Round Smooth Implants: Is it Worth it? An Evaluation of Patient- and Outcomes in 530 Consecutive Cases

BACKGROUND: The number of patients undergoing exchange of shaped, textured implants for round, smooth devices has greatly increased in the setting of BIA-ALCL. To date, there are no published studies evaluating long-term outcomes following these replacements. The objective of this study is thus to examine long-term patient- and surgeon-reported outcomes in terms of aesthetics, comfort, and complications. METHODS: A prospectively-collected database of all patients who underwent postmastectomy, implant-based reconstruction by a single surgeon (PGC) was analyzed. All patients who underwent initial reconstruction with shaped, textured implants which were then replaced with round, smooth implants between 1994-2022 with a minimum follow-up of 1 year were included. Demographics and peri-operative complications (hematoma, cellulitis, seroma) were recorded. Patient-reported outcomes (PROs) were collected using the BREAST-Q Reconstruction Module as well as a 5-point Likert scale surveying aesthetic outcome and comfort level. The BREAST-Q is a PRO measure administered to all patients undergoing breast reconstruction at our institution at the pre-operative visit followed by 3 months, 6 months, 1 year, 2 years, and 5 years post-operatively. Patients who had scores at least one year post-operatively were included. The following domains were evaluated in this study: Satisfaction with Breasts, Psychosocial Well-being, Physical Well-Being (Chest), and Sexual Well-Being. Values were converted to summary scores ranging from 0-100, and a difference of 4 points was considered clinically significant. Surgeon-reported outcomes included evaluation of aesthetics using a 5-point Likert scale and Baker classification of capsular contracture. RESULTS: In total, 530 patients were reviewed and 307 met inclusion criteria with a mean age of 46 and mean BMI of 23.25. Mean follow-up was 3.8 years. 74% of cases were bilateral and 22.8% had a history of radiation. Pairwise comparison of BREAST-Q data demonstrated statistically significant, long-lasting improvement in all domains. At one-year follow-up after exchange of shaped, textured implants to round, smooth implants, psychosocial well-being (72.68 to 76.45; p=0.0075) and physical well-being (78.79 to 81.88; p=0.0078) significantly increased. Overall breast satisfaction (61.94 to 67.27; p=0.0082) and sexual well-being (53.89 to 57.98; p=0.0002) were also significantly higher in parallel with a clinically significant increase in BREAST-Q score of 5.33 and 4.09 points, respectively. Most patients felt they looked better (56.4%) or the same (27.3%) and were more comfortable (54.4%) or the same (39.4%) after the exchange procedure. The senior surgeon rated 40.1% of patients as a better aesthetic grade after replacement and 50.3% as the same aesthetic grade. 36.8% of patients were rated as having a decrease in Baker capsular contracture grade and only 4.3% with increased contracture. 2.9% of patients experienced a peri-operative complication and there were no reconstructive failures. CONCLUSION: Exchange of textured to smooth implants is safe, does not appear to sacrifice aesthetic outcome, and provides a more comfortable and satisfactory outcome for patients with a low rate of complications. These results should be given consideration when counseling patients with textured implants and can aid in making an informed decision regarding exchange.

ASO Visual Abstract: Patient-Reported Outcome Measures in Patients with Clinical T4 Breast Cancer Treated with Mastectomy With and Without Reconstruction.

Do patient-reported outcome measures differ among clinical T4 patients undergoing mastectomy with and without reconstruction? Neither reconstruction nor timing of reconstruction were associated with superior outcomes for breast satisfaction, physical well-being of the chest, or psychosocial well-being at any timepoint.

Patient-Reported Outcome Measures for Patients Who Have Clinical T4 Breast Cancer Treated via Mastectomy with and Without Reconstruction.

Patients with clinical T4M0 breast cancer are recommended to undergo neoadjuvant chemotherapy, modified radical mastectomy, and postmastectomy radiotherapy. This study determined whether BREAST-Q scores differ by decision to pursue reconstruction or timing of reconstruction. This retrospective, single-institutional study analyzed cT4 breast cancer patients from 2014 to 2021 without evidence of distant metastatic disease undergoing mastectomy with or without reconstruction. As routine care, BREAST-Q was administered preoperatively, then 6 months, 1 year, and 2 years postoperatively. Satisfaction and quality-of-life domains were compared between mastectomy with no reconstruction (NR), immediate reconstruction (IR), and delayed reconstruction (DR) groups. Of the 144 patients eligible for this study, 71 (49%) had NR, 36 (25%) had DR, and 37 (26%) had IR. The patients undergoing reconstruction were younger and more likely to elect contralateral prophylactic mastectomy. Timing of reconstruction was not associated with significant differences in satisfaction with breasts (SATBR) at any time point. For the patients who had DR, breast satisfaction increased over time after reconstructive surgery. Physical well-being of the chest (PWB-CHEST) did not significantly differ among IR, DR, and NR at any time point. The patients who underwent DR experienced improvement in PWB-CHEST scores from preoperative scores. The patients with IR and NR experienced PWB-CHEST decline over time. Psychosocial well-being (PSWB) did not differ significantly across time or by subgroup. The patients with T4 breast cancer who elected reconstruction did not differ in patient-reported outcomes based on timing of reconstruction. In the DR cohort, SATBR significantly improved after reconstructive surgery. These data can help inform breast reconstructive decision-making for patients facing the choice among DR, IR, and NR.

허브 볼의 비수술적 처치를 통한 유방 확대에 따른 집단 간 비교분석

This study attempted to compare differences in breast augmentation, using herb ball therapy, one of traditional Thai therapeutic treatments as a nonsurgical method. For this, a total of 36 women in their 20-40s were collected from social media and online communities, and a questionnaire survey was performed against them to examine demographic characteristics and satisfaction and perception of their breast. Specifically, after measuring chest circumference, inter-nipple distance, collarbone-right nipple distance and collarbone-left nipple distance, the therapy was given, and breast satisfaction was examined. This experiment was performed once a week (3 times in total) against three different groups: a group of the massage pushing breast muscles into the nipples by creating a space in the back of breast after pectoralis fascia massage; a herb ball group in which breast muscles and blood are pushed into nipples, using heated herb balls by creating a space in the back of breast after temporal pectoralis fascia massage; control group (no treatment was given). The collected data were analyzed by SPSS 25.0. To examine breast augmentation effects, repeated measures two-way ANOVA was conducted, and the results found the followings: In terms of interactions, a statistical significance was found at each measurement by group (F(6, 99)=30.307, p<.001). In other words, all three groups revealed changes in breast circumference after each therapy. In particular, the herb ball group was relatively greater than the massage and control groups in terms of breast circumference improvements.

Psychosocial and sexual well-being in breast cancer survivors undergoing immediate breast reconstruction: The mediating role of breast satisfaction.

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.

Swedish Normative Scores for the BREAST-Q Reduction/Mastopexy Module

BackgroundNorm values for patient reported outcomes, that is knowledge about how the general population of women rate their breast-related satisfaction and quality of life, are necessary to interpret the meaning of scores. The aims of this study were to create Swedish normative values for the BREAST-Q reduction/mastopexy module and to describe what healthy women are most satisfied/dissatisfied with regarding their breasts.MethodsA random sample of 400 women aged 18-80, currently living in Region Västra Götaland, were sent BREAST-Q reduction/mastopexy. Descriptive data are presented.ResultsOne hundred and forty-six women answered the questionnaire (36.5%). Mean total scores ranged from 48 to 78. No clear changes in scores could be seen with age and women with a high BMI seem to be less satisfied with their breasts. The participants were most satisfied with the appearance of the breasts when dressed, the appearance in the mirror dressed, the shape of the breasts with bra, and symmetry of size and most dissatisfied with appearance in the mirror naked and the shape of the breasts without a bra. Thirty to forty-five per cent of healthy women never or almost never feel sexually attractive. Among physical symptoms often described in breast hypertrophy, the most common among healthy women were lack of energy, pain in the neck, arms and shoulders, headache and difficulty performing intense physical activity.ConclusionThe norms for BREAST-Q reduction/mastopexy add another piece to the puzzle to what constitutes normal breast satisfaction and how surgical outcomes can be evaluated.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Breast satisfaction in adult women with Turner syndrome-An international survey employing the BREAST-Q questionnaire.

Turner syndrome (TS) is associated with short stature, delayed puberty, primary ovarian insufficiency, and other features. Most girls with TS require oestrogen replacement for pubertal induction. There is paucity of data in adult TS on pubertal outcomes, including breast satisfaction. Here, we assess breast satisfaction in TS with the BREAST-Q questionnaire, a well-validated patient-related outcome measure (PROM). International survey distributed online through TS support groups. Adult women aged 18-45 years with TS (self-reported). The questionnaire contained demographics, health history and the four domains of the BREAST-Q. BREAST-Q scores were matched on a one-to-one basis for age, body mass index(BMI) and educational background to a normative data set derived from the 'Army of Women', an online community of healthy volunteers. Of 97 total responses, 74 could be matched to the control cohort. Median age was 32 years (18-45 years) and 97% were White Caucasian. Median age at menarche was 15.5 years (12-34 years), 86% had received pubertal induction therapy as teenagers. We found significantly lower BREAST-Q scores in TS in the domains 'Satisfaction with Breast' (p = .021), 'Psychosocial Wellbeing' (p < .0001) and 'Sexual Wellbeing' (p < .0001). TS who had received oestrogen replacement therapy reported lower scores compared to TS who had not received oestrogen therapy (p < .0001). Lower BMI and previous growth hormone therapy were associated with lower breast satisfaction. TS women who received oestrogen replacement for pubertal induction self-report lower breast satisfaction scores and late menarche, suggesting that type, mode of delivery, dose and timing of hormone supplements merit prospective study.

Long-Term Patient Satisfaction and Quality of Life Following Breast Reconstruction Using the BREAST-Q: A Prospective Cohort Study.

BackgroundBreast reconstruction is a promising surgical technique to improve health-related quality of life (HRQoL) in patients with breast cancer. However, the long-term risk factors associated with HRQoL after breast surgery are still unclear. Our aim was to evaluate breast satisfaction and HRQoL following breast reconstruction to identify clinical factors associated with each domain of BREAST-Q in the long-term.MethodsPatient-reported BREAST-Q outcomes were analyzed 1 and 5 years after breast reconstruction in a single-blinded, prospective study. Multiple regression analysis was performed to identify the risk and protective factors associated with BREAST-Q scores. These scores at 1 and 5 years were also compared across three types of operation: mastectomy only, tissue expander/implant (TE/Imp), and a deep inferior epigastric perforator (DIEP) flap.ResultsSurveys were completed by 141 subjects after 1 year and 131 subjects after 5 years. Compared to mastectomy only, breast reconstruction was significantly associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p < 0.001; DIEP, p < 0.001), higher body mass index (BMI) resulted in lower “Satisfaction with breasts” (p = 0.004), and a history of psychiatric or neurological medication was significantly associated with “Physical well-being” at 1-year postoperatively (p = 0.02). At 5 years, reconstructive procedures were significantly positively associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p = 0.03; DIEP, p < 0.001), and a bilateral procedure was a significant risk factor for lower “Psychosocial well-being” (p = 0.02).ConclusionsThe results of this study show that breast reconstruction improves “Satisfaction with Breasts” and “Psychosocial well-being” compared to mastectomy. Among all three types of operation, DIEP gave the best scores at 5 years postoperatively. Thus, autologous reconstruction is recommended for promotion of long-term HRQoL after breast surgery.

Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction

Treatment options for early breast cancer include breast-conserving surgery with radiation therapy (RT) or mastectomy and breast reconstruction without RT. Despite marked differences in these treatment strategies, little is known with regard to their association with long-term quality of life (QOL). To evaluate the association of treatment with breast-conserving surgery with RT vs mastectomy and reconstruction without RT with long-term QOL. This comparative effectiveness research study used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. The study sample was mailed a survey between March 2017 and April 2018. Data were analyzed from August 1, 2018 to October 15, 2021. Breast-conserving surgery with RT or mastectomy and reconstruction without RT. The primary outcome was satisfaction with breasts, measured with the BREAST-Q patient-reported outcome measure. Secondary outcomes included BREAST-Q physical well-being, psychosocial well-being, and sexual well-being; health utility, measured using the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level questionnaire; and local therapy decisional regret. Multivariable linear regression models with weights for treatment, age, and race and ethnicity tested associations of the exposure with outcomes. Of 647 patients who responded to the survey (40.0%; 356 had undergone breast-conserving surgery, and 291 had undergone mastectomy and reconstruction), 551 (85.2%) confirmed treatment with breast-conserving surgery with RT (n = 315) or mastectomy and reconstruction without RT (n = 236). Among the 647 respondents, the median age was 53 years (range, 23-85 years) and the median time from diagnosis to survey was 10.3 years (range, 8.4-12.5 years). Multivariable analysis showed no significant difference between breast-conserving surgery with RT (referent) and mastectomy and reconstruction without RT in satisfaction with breasts (effect size, 2.71; 95% CI, -2.45 to 7.88; P = .30) or physical well-being (effect size, -1.80; 95% CI, -5.65 to 2.05; P = .36). In contrast, psychosocial well-being (effect size, -8.61; 95% CI, -13.26 to -3.95; P < .001) and sexual well-being (effect size, -10.68; 95% CI, -16.60 to -4.76; P < .001) were significantly worse with mastectomy and reconstruction without RT. Health utility (effect size, -0.003; 95% CI, -0.03 to 0.03; P = .83) and decisional regret (effect size, 1.32; 95% CI, -3.77 to 6.40; P = .61) did not differ by treatment group. The findings support equivalence of breast-conserving surgery with RT and mastectomy and reconstruction without RT with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with RT was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer.

Sexual Well-Being After Nipple-Sparing Mastectomy: Does Preservation of the Nipple Matter?

The primary aim of this study was to evaluate patient-reported outcome measures in patients undergoing mastectomy with and without breast reconstruction (immediate or delayed) with and without nipple preservation. All female patients undergoing mastectomy between 2011 and 2015 at Mayo Clinic Rochester were identified and were mailed the BREAST-Q survey. Breast satisfaction, psychosocial well-being, and sexual well-being were evaluated and compared by surgery type using Wilcoxon rank-sum tests for univariate analysis and linear regression for multivariable analysis adjusting for potential confounders. Of 1547 patients, 771 completed the BREAST-Q survey (response rate 50%). Of these 771 respondents, 237 (31%) did not have reconstruction, 198 (26%) had nipple-sparing mastectomy with reconstruction (NSM), and 336 (44%) had skin-sparing mastectomy with reconstruction (SSM) ± nipple-areolar complex (NAC) reconstruction (via surgery±tattoo). Patients with breast reconstruction had consistently higher BREAST-Q scores versus those without. Comparing NSM with all SSMs, there was no difference in satisfaction with breasts (mean 71.8 vs. 70.2, p=0.21) or psychosocial well-being (mean 81.9 vs. 81.3, p=0.47); however, sexual well-being was significantly higher in the NSM group on univariate (mean 64.5 vs. 58.0, p=0.002) and multivariable (β=-4.69, p=0.03) analysis. Sexual well-being scores were similar for NSM and the SSM subgroups with any type of NAC reconstruction. This study demonstrates that NSM positively impacts patient sexual well-being after breast reconstruction compared with SSM, particularly SSM without nipple reconstruction or tattoo. SSM with any type of NAC reconstruction achieved similar satisfaction and sexual well-being to those undergoing NSM.

Matched Preliminary Analysis of Patient-Reported Outcomes following Autologous and Implant-Based Breast Reconstruction.

Comparisons of autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR) involve unavoidable confounders, which are often adjusted for in post hoc regression analyses. This study compared patient-reported outcomes between ABR patients and IBR patients by using propensity score matching to control for confounding variables upfront. Propensity score matching analysis (2:1 nearest-neighbor matching with replacement) was performed for patients who underwent ABR or IBR without radiotherapy. Matched covariates included age, body mass index, history of psychiatric diagnosis, race-ethnicity, smoking status, and laterality of reconstruction. Outcomes of interest were BREAST-Q questionnaire scores for breast satisfaction and well-being. Of the 2334 patients identified, 427 were included in the final analysis: 159 who underwent ABR and 268 who underwent IBR. The ABR group matched the IBR group in the selected characteristics. ABR patients did not differ significantly from IBR patients in breast satisfaction or well-being at either 1 or 2 years after reconstructive surgery. This preliminary analysis of immediate breast reconstruction patients not requiring radiation therapy with similar propensities for ABR or IBR suggests comparable levels of breast satisfaction and well-being within 2 years after reconstructive surgery. Further research is needed with larger sample sizes, statistical power, and follow-up to better understand patient reported outcomes in this population, as the current findings differ from studies where patients were not matched on baseline characteristics.

P157. A PROSPECTIVE EXPLORATION OF THE QUALITY OF LIFE AND MENTAL HEALTH IMPLICATIONS OF MASTECTOMY ALONE ON WOMEN IN SUB-SAHARAN AFRICA

PURPOSE: Breast cancer is the most common cause of malignancy-related mortality worldwide. Stark disparities in survival in sub-Saharan Africa (SSA) have been attributed to presentation delays. Fears of mastectomy are a prominent reason. This study assesses quality of life and mental health implications of mastectomy in African women. METHODS: Women in Ghana and Ethiopia, with breast cancer undergoing mastectomy were followed prospectively. Demographics, clinical and treatment variables were collected. Breast related quality of life and mental health measures were evaluated preoperatively and six months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Univariate tests and logistic regression analyses evaluated changes in these measures and assessed regional differences. RESULTS: 125 women were recruited, 50 from Ghana and 75 from Ethiopia. Over 50% were diagnosed with stage III or IV disease. Radiation was more common in Ghana (p <0.001). At six months, the entire cohort of women reported decreased scores for breast satisfaction (mean difference, -6.0) and sexual well-being (mean difference, -8.7). Ghanaian women reported decreased BREAST-Q scores for all measured satisfaction and quality of life domains and Ethiopian women reported increased scores across the same domains. Women in both countries reported similar significant improvements in anxiety and depression postoperatively. CONCLUSION: This study demonstrates previously undescribed quality of life experiences, with interesting regional variations, amongst women in Ghana and Ethiopia undergoing mastectomy and provides evidence of mental health benefits of mastectomy. This is vital information as we seek to understand reasons for women’s fears and work to improve on breast cancer care in SSA.

P60. PATIENT FACTORS THAT AFFECT PRE-OPERATIVE PATIENT REPORTED OUTCOMES IN WOMEN UNDERGOING BREAST CANCER SURGERY

PURPOSE: Understanding the impact of patient, disease, and treatment factors on pre-operative patient reported outcomes (PROs) is important to guide surgical decision-making with breast cancer. METHODS: This prospective cohort study evaluates PROs in women undergoing breast cancer treatment at a metropolitan health care system. New cases undergo tumor board discussion and same-day consultations with various specialties. Women choose to complete pre- and post-operative Breast-Q© Breast Conserving Surgery(BCS), Mastectomy(M), or Reconstruction(R) modules and demographic surveys. Individual associations to pre-operative Breast-Q survey scores were assessed using linear regression models (one for each Breast-Q survey type). Variables significant for at least one survey were included in multiple linear regression models. RESULTS: 375 women completed the pre-operative surveys (BCS=244, M=39, BR=92). Procedure choice, laterality, race, marital status, employment, prior breast cancer, neoadjuvant chemotherapy, or history of radiation or chemotherapy did not impact PROs. Breast satisfaction decreased with higher BMI (est=-0.367, p=0.045) and stage 2 disease (est=-11.011 (vs. stage 0), p=0.008). Lower psychosocial score was associated with younger age (est=0.271, p=0.002), higher BMI (est=-0.367, p=0.014), and income <35k (est=0.172 (vs. 35k+), p=0.016). Similarly, lower physical well-being of the chest was associated with younger age (est=0.207, p=0.011), higher BMI (est=-0.285, p=0.039), and income <35k (est=0.218 (vs. 35k+, p=0.039). Sexual well-being decreased with higher BMI (est=-0.545, p=0.004) and income <35k (est=0.135 (vs. 35k+), p=0.016). CONCLUSION: While factors such as age, BMI, and stage of disease are difficult to change prior to surgery, patients with lower income may need special interventions to assist them through the treatment process.

Patient reported outcomes following breast conserving surgery are improved by minimizing re-excisions and excessive breast tissue removal

BackgroundPatient reported outcomes (PRO's) are a valuable tool in obtaining the patients' perspective on the effectiveness of breast conservation surgery. Investigation has primarily been focused on patient and disease related factors impacting PRO's, with a limited focus on surgically modifiable factors. We investigate the impact that the volume of breast tissue removed, and performance of re-excisions have on PRO's. MethodsRetrospective evaluation of the BREAST-Q (breast conservation module) in patients undergoing breast conserving surgery over a 3 year period. Multivariate analysis of patient, disease, and treatment related factors impacting PRO's. Results163 patients completed the BREAST-Q. The median satisfaction with breast score was 67 (IQR, 48–88). Increasing volume of resected breast tissue was negatively associated with appearance of the breast (−0.05/cm3 (CI; −0.08 to −0.01)), as was the performance of re-excisions (−6.59 (CI; −14.73 – 0)). Physical well-being of chest was negatively associated with the volume of breast tissue removed (−0.05/cm3 (CI; −0.08 – 0)), but not re-excisions. Psychosocial well-being was negatively affected by the volume of tissue removed ((-0.04/cm3(CI; −0.07 – 0)), and re-excisions (−2.88 (CI; −10.96 – 0)). Patient body mass index, disease stage, receipt of Tamoxifen, as well as axillary lymph node dissection also impacted BREAST-Q domain scores. ConclusionThe removal of larger volumes of breast tissue and performance of re-excisions negatively impact patient quality of life and breast satisfaction following breast conserving surgery. Optimal patient reported outcomes are associated with accurate tumour removal, which minimizes re-excisions and the removal of normal breast tissue.