Quality of Life in Breast Cancer Survivors: Comparative Study of Mastectomy, Mastectomy with Immediate Transverse Rectus Abdominis Musculocutaneous Flap Reconstruction and Breast Conserving Surgery
Satit Srimontayamas MD*, Doonyapat Sa-nguanraksa MD, PhD*, Visnu Lohsiriwat MD*, Pradit Rushatamukayanunt MD, PhD*, Waraporn Imruetaicharoenchoke MD*, Poramaporn Prasartong-Osoth MD*, Suebwong Chuthapisith MD, PhD*, Adune Ratanawichitrasin MD*, Supakorn Rojananin MD*, Kris Bhothisuwan MD*, Pornchai O-charoenrat MD, PhD*
Affiliation : * Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Surgical treatment of early-stage breast cancer either with mastectomy alone, mastectomy with reconstruction,
or breast-conserving surgery (BCS) is equivalent in terms of disease control. Therefore, the choice of surgical procedures
often depends on quality of life (QoL) consideration. Conflicting data exists whether which surgical procedure results in better
QoL.
Objective : To examine long-term effects of different surgical treatments on QoL in Thai women with breast cancer
Material and Method: Two hundred and sixty-five women who underwent mastectomy alone (TM) (n = 113), BCS (n = 109)
and mastectomy with immediate transverse rectus abdominis muscle flap reconstruction (TM-TRAM) (n = 43) were included
in the study. QoL was assessed at least 6 months after completion of definitive treatment using the Functional Assessment of
Cancer Therapy-General and Breast Cancer Specific (FACT-G and FACT-B).
Results : There was no difference in occupation, graduation, marital and menopausal status of patients among the three
groups. However, women who underwent BCS presented at an earlier stage and received fewer axillary lymph node
dissection than those with TM or TM-TRAM. During long-term follow-up period (6 months to 10 years after surgery), women
in all groups experienced relatively high QoL (>80%) in physical and emotional domains. In multivariate regression
analyses adjusted for age, stage, type of axillary surgery, and type of nonsurgical treatment, there was no significant difference
in QoL among the three groups (p = 0.056 for FACT-G and p = 0.275 for FACT-B).
Conclusion : This comparative report of QoL assessment in Thai breast cancer patients demonstrated that QoL in general
aspects and breast-specific symptoms are not better in women who undergo BCS or TM-TRAM than in women who have TM.
Counseling for surgical option and letting the patient participate in decision-making might improve emotional well-being and
satisfaction.
Keywords : Breast cancer, Quality of life, Breast conserving surgery, Total mastectomy, Immediate breast reconstruction
