Postoperative Quality of Life in Patients Undergoing Contralateral Prophylactic Mastectomy with Breast Reconstruction
Amanda M. Rizzo, BA, Evan S. Garfein, MD, Teresa Benacquista, MD, Lawrence Draper, MD, J. Alejandro Conejero, MD, Katie E. Weichman, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Purpose: The aim of this study was to evaluate postoperative satisfaction and quality of life in women who chose to undergo contralateral prophylactic mastectomy (CPM) with reconstruction compared to those opting for unilateral procedures.
Methods: Women undergoing immediate breast reconstruction at Montefiore Medical Center between June 2015 and September 2017 were prospectively enrolled in this study. For analysis, women were divided into two groups: those undergoing unilateral reconstruction and those undergoing bilateral reconstruction with CPM indication. Patient demographics, body mass index (BMI), cancer characteristics, adjuvant therapy, mastectomy weight, and complication rates were analyzed with bivariate statistics (t-tests, Mann-Whitney, and Chi-Square as appropriate). Preoperative and postoperative BREAST-Q survey scores were compared between groups using t-tests or Mann-Whitney tests after assessing for normality of score distribution.
Results: Sixty-four women were included for analysis (CPM n=28 (44%), unilateral n=36 (56%)). Mean age of the two groups differed significantly (CPM 44±9; unilateral 52±8; p<0.001). Mean BMI, race/ethnicity (overall 84% Black or Hispanic), education, income, and mastectomy weight did not differ between groups. Women in CPM group had higher rates of adjuvant therapy (CPM=36% both chemo and radiation, unilateral=6%; p=0.02). The rate of having any postoperative complication was higher in CPM group (CPM=50%, unilateral=25%; p=0.04). The median postoperative survey time was 11.8 (IQR 6-13) months. For satisfaction with breasts, mean postoperative-preoperative score difference varied significantly between groups, with CPM group having higher and unilateral group having lower satisfaction in the postoperative period relative to preoperative assessment (CPM=7.5±27, unilateral=-11.4±26; p<0.01). Median postoperative scores for satisfaction with breasts (CPM = 58 [IQR 53-65.5], unilateral= 54.5 [IQR 39.5-61.5]; p=0.13), satisfaction with outcome (CPM = 67 [IQR 55-75], unilateral= 74 [IQR 55-86]; p=0.45), psychosocial well-being (CPM = 55 [IQR 44.5-73], unilateral= 65 [IQR 41-86]; p=0.53), and sexual well-being (CPM = 44 [IQR 26-58], unilateral= 50.5 [IQR 32-56.5]; p=0.52) did not differ between groups.
Discussion: Patients electing for CPM are younger and have more advanced disease than those who chose unilateral mastectomy with reconstruction. Despite higher rates of complications in patients undergoing CPM, improved satisfaction with breasts postoperatively may reflect greater satisfaction with breast symmetry.
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