title: Quality of life after mastectomy with or without immediate breast reconstruction.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre Jean Perrin, Clermont Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Dauplat
authors.affiliation: Centre Jean Perrin, Clermont Ferrand, France.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-4041-3999
authors.initials: F
authors.lastname: Kwiatkowski
authors.affiliation: Centre Val d'Aurelle Paul Lamarque, Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Rouanet
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Delay
authors.affiliation: Institut du Sein, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Clough
authors.affiliation: Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Verhaeghe
authors.affiliation: Centre Antoine Lacassagne, Nice, France.
authors.forename: I
authors.initials: I
authors.lastname: Raoust
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Centre René Huguenin, Institut Curie, Saint Cloud, France.
authors.forename: P
authors.initials: P
authors.lastname: Lemasurier
authors.affiliation: Centre Jean Perrin, Clermont Ferrand, France.
authors.forename: E
authors.initials: E
authors.lastname: Thivat
authors.affiliation: Centre Jean Perrin, Clermont Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Pomel
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D000071960:Breast Carcinoma In Situ / Q000523:psychology / Q000601:surgery*; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000523:psychology; D008408:Mastectomy / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D017060:Patient Satisfaction; D011182:Postoperative Care; D057216:Propensity Score; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires