title: Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures.
abstract: BACKGROUND
  Published data on quality of life in women after breast reconstruction are inconsistent. This cross-sectional study evaluated the quality of life of women after successful breast reconstruction in comparison with those who underwent mastectomy alone.
  
  
  METHODS
  The quality of life was evaluated using two validated self-report questionnaires: the BREAST-Q and the RAND-36. Demographic information, patient anxiety, depression, and concerns about recurrences were measured by using standardized questionnaires. These questionnaires were sent to the participants. The quality of life of the mastectomy plus breast reconstruction group (n=92) and the mastectomy-alone group (n=45) were compared. Multiple regression analysis was used to evaluate the statistical significance of the authors' findings.
  
  
  RESULTS
  Women with successful breast reconstruction were significantly more satisfied with the appearance of their chest/breasts (p=0.003). They also fared better psychosocially (n=0.008) and sexually (p=0.007) than women with mastectomy alone. Furthermore, they functioned better physically (p=0.012), experiencing less pain and fewer limitations (p=0.007).
  
  
  CONCLUSIONS
  Successful breast reconstruction following mastectomy can greatly improve different aspects of the patient's life compared with women who do not undergo reconstructive surgery. These findings might be taken into consideration when the treating medical team and the patient study various treatment options.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Groningen, The Netherlands From the University Medical Center Groningen.
authors.forename: Yassir
authors.initials: Y
authors.lastname: Eltahir
authors.forename: Lisanne L C H
authors.initials: LLCH
authors.lastname: Werners
authors.forename: Marieke M
authors.initials: MM
authors.lastname: Dreise
authors.forename: Ingeborg A Zeijlmans
authors.initials: IAZ
authors.lastname: van Emmichoven
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Jansen
authors.forename: Paul M N
authors.initials: PMN
authors.lastname: Werker
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000523:psychology*; D008408:Mastectomy / Q000379:methods / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D018434:Sickness Impact Profile; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
references.citation: Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90
references.citation: Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE Study Group. J Clin Oncol. 2004;22:1055–1062
references.citation: Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93:1633–1637
references.citation: Metcalfe KA, Semple J, Quan ML, et al. Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction. Ann Surg Oncol. 2012;19:233–241
references.citation: Helms RL, O’Hea EL, Corso M. Body image issues in women with breast cancer. Psychol Health Med. 2008;13:313–325
references.citation: Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks PJ, Bloom JR. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15:579–594
references.citation: McGaughey A. Body image after bilateral prophylactic mastectomy: An integrative literature review. J Midwifery Womens Health. 2006;51:e45–e49
references.citation: Lee C, Sunu C, Pignone M. Patient-reported outcomes of breast reconstruction after mastectomy: A systematic review. J Am Coll Surg. 2009;209:123–133
references.citation: Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92:1422–1429
references.citation: Chen CM, Cano SJ, Klassen AF, et al. Measuring quality of life in oncologic breast surgery: A systematic review of patient-reported outcome measures. Breast J. 2010;16:587–597
references.citation: Winters ZE, Benson JR, Pusic AL. A systematic review of the clinical evidence to guide treatment recommendations in breast reconstruction based on patient- reported outcome measures and health-related quality of life. Ann Surg. 2010;252:929–942
references.citation: Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg. 2009;124:345–353
references.citation: van den Beuken-van Everdingen MH, Peters ML, de Rijke JM, Schouten HC, van Kleef M, Patijn J. Concerns of former breast cancer patients about disease recurrence: A validation and prevalence study. Psychooncology. 2008;17:1137–1145
references.citation: Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. J Psychosom Res. 2002;52:69–77
references.citation: Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27:363–370
references.citation: Vickberg SM. The Concerns About Recurrence Scale (CARS): A systematic measure of women’s fears about the possibility of breast cancer recurrence. Ann Behav Med. 2003;25:16–24
references.citation: Klassen AF, Pusic AL, Scott A, Klok J, Cano SJ. Satisfaction and quality of life in women who undergo breast surgery: A qualitative study. BMC Womens Health. 2009;9:11
references.citation: Aaronson NK, Muller M, Cohen PD, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51:1055–1068
references.citation: Lee C, Sunu C, Pignone M. Patient-reported outcomes of breast reconstruction after mastectomy: A systematic review. J Am Coll Surg. 2009;209:123–133
references.citation: Guyomard V, Leinster S, Wilkinson M. Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast. 2007;16:547–567
references.citation: Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26:3331–3337
references.citation: Bellino S, Fenocchio M, Zizza M, Rocca G, Bogetti P, Bogetto F. Quality of life of patients who undergo breast reconstruction after mastectomy: Effects of personality characteristics. Plast Reconstr Surg. 2011;127:10–17
references.citation: Zhong T, McCarthy C, Min S, et al. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: A prospective analysis of early postoperative outcomes. Cancer. 2012;118:1701–1709
references.citation: Medina-Franco H, García-Alvarez MN, Rojas-García P, Trabanino C, Drucker-Zertuche M, Arcila D. Body image perception and quality of life in patients who underwent breast surgery. Am Surg. 2010;76:1000–1005
references.citation: Yueh JH, Slavin SA, Adesiyun T, et al. Patient satisfaction in postmastectomy breast reconstruction: A comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg. 2010;125:1585–1595