• Reshma Jagsi, Yun Li, Monica Morrow, Nancy Janz, Amy Alderman, John Graff, Ann Hamilton, Steven Katz, and Sarah Hawley.
• *University of Michigan Medical School, Ann Arbor, MI †University of Michigan School of Public Health, Ann Arbor, MI ‡Memorial Sloan Kettering Cancer Center, New York, NY §The Swan Center for Plastic Surgery, Alpharetta, GA ¶Rutgers Cancer Institute of New Jersey, New Brunswick, NJ ‖University of Southern California, Los Angeles, CA; and **Ann Arbor VA Medical Center, Ann Arbor, MI.
• Ann. Surg. 2015 Jun 1; 261 (6): 1198-206.

ObjectiveAlthough breast conservation is therapeutically equivalent to mastectomy for most patients with early-stage breast cancer, an increasing number of patients are pursuing mastectomy, which may be followed by breast reconstruction. We sought to evaluate long-term quality of life and cosmetic outcomes after different locoregional management approaches, as perceived by patients themselves.MethodsWe surveyed women with a diagnosis of nonmetastatic breast cancer from 2005 to 2007, as reported to the Los Angeles and Detroit population-based Surveillance, Epidemiology, and End Results registries. We received responses from 2290 women approximately 9 months after diagnosis (73% response rate) and from 1536 of these 4 years later. We evaluated quality of life and patterns and correlates of satisfaction with cosmetic outcomes overall and, more specifically, within the subgroup undergoing mastectomy with reconstruction, using multivariable linear regression.ResultsOf the 1450 patients who responded to both surveys and experienced no recurrence, 963 underwent breast-conserving surgery, 263 mastectomy without reconstruction, and 222 mastectomy with reconstruction. Cosmetic satisfaction was similar between those receiving breast conservation therapy and those receiving mastectomy with reconstruction. Among patients receiving mastectomy with reconstruction, reconstruction type and radiation receipt were associated with satisfaction (P < 0.001), with an adjusted scaled satisfaction score of 4.7 for patients receiving autologous reconstruction without radiation, 4.4 for patients receiving autologous reconstruction and radiation therapy, 4.1 for patients receiving implant reconstruction without radiation therapy, and 2.8 for patients receiving implant reconstruction and radiation therapy.ConclusionsPatient-reported cosmetic satisfaction was similar after breast conservation and after mastectomy with reconstruction. In patients undergoing postmastectomy radiation, the use of autologous reconstruction may mitigate the deleterious impact of radiation on cosmetic outcomes.

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