Quality Of Life Among Chinese Women With Breast Cancer After Modified Radical Mastectomy And Immediate Autologous Breast Reconstruction:a Comparative Study

BackgroundBreast cancer is the most common cancer in women in the worldwide. In China, breast cancer is the second common cancer, with almost0.169million new cases a year. Breast cancer treatment has been suggested to change body reality and body ideal, and may affect quality of life (QOL), so it is important to assess the QOL and patient satisfaction outcomes. Modified radical mastectomy remains a mainstay of treatment, and immediate autologous breast reconstruction is developing in China, which restores breast symmetry after a mastectomy by creating a breast mound, associated with improved body image. However, little study has been done in comparing outcomes for Chinese women receiving traditional mastectomy alone versus sparing mastectomy with immediate breast reconstruction.ObjectivesThe aim of this study is to evaluate whether immediate autologous breast reconstruction influences QOL and patient satisfaction outcomes among Chinese women with breast cancer in comparison to the modified radical mastectomy.MethodsSixty patients with breast cancer who were operated from July2011to July2012in Cancer Institute&Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were included:group Ⅰ (30patients) underwent traditional mastectomy and group II (30patients) underwent mastectomy with immediate autologous breast reconstruction, which included latissimus dorsi flap (n＝20) and free transverse rectus abdominis myocutaneous (TRAM) flap (n=10). The patient satisfaction with breast reconstruction was evaluated by functional assessment of cancer therapy-breast cancer scale (FACT-B), psychological effect of treatment scale, body satisfaction scale, and a specific questionnaire regarding satisfaction of postoperative breasts designed by ourselves.Data were analyzed using the statistical package for the social sciences to test the statistical significant difference between the two groups. The mean±standard deviation (SD) and frequency and proportion describe the qualitative data. Student t-test was conducted to investigate quantitative data between the two groups. Chi-square test was conducted to investigate qualitative data. Significant level of P value is<0.05.ResultsGroup Ⅱ showed higher educational levels than group Ⅰ (66.7%vs.43.3%, P=0.04), and there were no significant differences between both groups as regard breast cup size, fear from recurrence, histopathologic characteristics and incision condition (P>0.05). Compared with the group Ⅰ, the patients in the group Ⅱ (immediate autologous breast reconstruction) had better body image satisfaction outcomes (41.1±10.8vs.33.2±8.8, P=0.003), and the difference was still exist after adjustment for confounding factors by multiple linear regression. No significant difference were found between the two groups as regard total FACT-B score, physical status, functional status, social/family status, emotional status and additional attention status (P>0.05). Group Ⅱ had a lower psychological evaluation score than group Ⅰ, however there was no statistic difference (29.3±11.8vs.324±10.4, P=0.281). In the group of immediate autologous breast reconstruction, no difference was found between the patients with latissimus dorsi flap (n=20) and the patients with TRAM flap as regard the all scores.ConclusionChinese woman who choose immediate breast reconstruction had higher educational levels those had modified radical mastectomy. They had better body image satisfaction outcomes. However, there was no significant difference between the two groups as regard total FACT-B score (QOL), which may relate to the small sample size.