Background: Breast cancer is considered a chronic disease owing to the increases in survival rate. Thus, better body image and patient satisfaction with the surgery have become more important factors to be considered when choosing the surgical approach. The aim of this study was to compare body image and patient satisfaction following three different approaches.
Methods: We evaluated 183 consecutive patients who had undergone three different surgeries including breast-conserving surgery (BCS), mastectomy, or mastectomy followed by reconstruction (M-R). Body image was evaluated using the BICI questionnaire, and patient satisfaction was rated using a multiple-choice question and a scale ranging from 1 to 10.
Results: A significantly better body image was observed in the M-R and BCS groups compared with mastectomy (P = 0.02). In body image subscale analysis, social functioning scores were higher in the M-R and BCS groups than in the mastectomy group (P = 0.01), but no differences were obtained between surgery groups in appearance dissatisfaction subscale. Patients were more satisfied with BCS than the other two surgeries (P = 0.008).
Conclusion: Based on the results of this study, it could be proposed that both oncoplastic BCS and implant reconstruction could provide patients with acceptable body image, while BCS could bring about better satisfaction with the surgery. Reconstruction may be an alternative for the patients to improve body image and satisfaction when BCS is not applicable.
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Harirchi I, Karbakhsh M, Montazeri A, Ebrahimi M, Jarvandi S, Zamani N, et al. Decreasing trend of tumor size and downstaging in breast cancer in Iran: results of a 15-year study. Eur J Cancer Prev. 2010;19(2):126-30.
Harirchi I, Kolahdoozan S, Karbakhsh M, Chegini N, Mohseni SM, Montazeri A, et al. Twenty years of breast cancer in Iran: downstaging without a formal screening program. Ann Oncol. 2011;22(1):93-7.
Asadzadeh Vostakolaei F, Broeders MJ, Mousavi SM, Kiemeney LA, Verbeek AL. The effect of demographic and lifestyle changes on the burden of breast cancer in Iranian women: a projection to 2030. Breast. 2013;22(3):277-81.
Sinaei F, Zendehdel K, Adili M, Ardestani A, Montazeri A, Mohagheghi MA. Association Between Breast Reconstruction Surgery and Quality of Life in Iranian Breast Cancer Patients. Acta Med Iran. 2017;55(1):35-41.
Olfatbakhsh A, Mehrdad N, Ebrahimi M, Alavi N, Hashemi E, Kaviani A, et al. Evaluation of factors impacting cosmetic outcome of breast conservative surgery--a study in Iran. Asian Pac J Cancer Prev. 2015;16(6):2203-7.
Schmauss D, Machens HG, Harder Y. Breast Reconstruction after Mastectomy. Front Surg. 2015;2:71.
Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305(1):6-11.
Fisher B, Fisher ER, Redmond C. Ten-year results from the National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trial evaluating the use of L-phenylalanine mustard (L-PAM) in the management of primary breast cancer. J Clin Oncol. 1986;4(6):929-41.
Gomez SL, Lichtensztajn D, Kurian AW, Telli ML, Chang ET, Keegan TH, et al. Increasing mastectomy rates for early-stage breast cancer? Population-based trends from California. J Clin Oncol. 2010;28(10):e155-7; author reply e8.
Mahmood U, Hanlon AL, Koshy M, Buras R, Chumsri S, Tkaczuk KH, et al. Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann Surg Oncol. 2013;20(5):1436-43.
Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27(25):4082-8.
Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203-9.
Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):1551-6.
Huang J, Chagpar AB. Quality of Life and Body Image as a Function of Time from Mastectomy. Ann Surg Oncol. 2018;25(10):3044-51.
Fang SY, Shu BC, Chang YJ. The effect of breast reconstruction surgery on body image among women after mastectomy: a meta-analysis. Breast Cancer Res Treat. 2013;137(1):13-21.
Mayor S. NICE updates guidance on early and advanced breast cancer. BMJ. 2009;338:b815.
Oiz B. [Breast reconstruction and psychological benefit]. An Sist Sanit Navar. 2005;28 Suppl 2:19-26.
Wilkins EG, Cederna PS, Lowery JC, Davis JA, Kim HM, Roth RS, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106(5):1014-25; discussion 26-7.
Filiberti A, Tamburini M, Murru L, Lovo GF, Ventafridda V, Arioli N, et al. Psychologic effects and esthetic results of breast reconstruction after mastectomy. Tumori. 1986;72(6):585-8.
Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg. 2008;247(6):1019-28.
Golshan M, Cirrincione CT, Sikov WM, Berry DA, Jasinski S, Weisberg TF, et al. Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance). Ann Surg. 2015;262(3):434-9; discussion 8-9.
Lee C, Sunu C, Pignone M. Patient-reported outcomes of breast reconstruction after mastectomy: a systematic review. J Am Coll Surg. 2009;209(1):123-33.
Pruzinsky T. Enhancing quality of life in medical populations: a vision for body image assessment and rehabilitation as standards of care. Body Image. 2004;1(1):71-81.
Fingeret MC, Nipomnick SW, Crosby MA, Reece GP. Developing a theoretical framework to illustrate associations among patient satisfaction, body image and quality of life for women undergoing breast reconstruction. Cancer Treat Rev. 2013;39(6):673-81.
Klassen AF, Pusic AL, Scott A, Klok J, Cano SJ. Satisfaction and quality of life in women who undergo breast surgery: a qualitative study. BMC Womens Health. 2009;9:11.
Urcuyo KR, Boyers AE, Carver CS, Antoni MH. Finding benefit in breast cancer: relations with personality, coping, and concurrent well-being. Psychol Health. Psychol Health. 2005;2(20):175-92.
Carver CS, Pozo-Kaderman C, Price AA, Noriega V, Harris SD, Derhagopian RP, et al. Concern about aspects of body image and adjustment to early stage breast cancer. Pschycosom Med.1998 ;60(2):168-74.
Moreira H, Silva S, Canavarro MC. The role of appearance investment in the adjustment of women with breast cancer. Psychooncology. 2010;19(9):959-66.
Kulkarni AR, Pusic AL, Hamill JB, Kim HM, Qi J, Wilkins EG, et al. Factors Associated with Acute Postoperative Pain Following Breast Reconstruction. JPRAS Open. 2017;11:1-13.
Gopie JP, Timman R, Hilhorst MT, Hofer SO, Mureau MA, Tibben A. The short-term psychological impact of complications after breast reconstruction. Psychooncology. 2013;22(2):290-8.
Andrade WN, Baxter N, Semple JL. Clinical determinants of patient satisfaction with breast reconstruction. Plast Reconstr Surg. 2001;107(1):46-54.
Murray CD, Turner A, Rehan C, Kovacs T. Satisfaction following immediate breast reconstruction: Experiences in the early post-operative stage. Br J Health Psychol. 2015;20(3):579-93.
Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36(15):1938-43.
Gopie JP, ter Kuile MM, Timman R, Mureau MA, Tibben A. Impact of delayed implant and DIEP flap breast reconstruction on body image and sexual satisfaction: a prospective follow-up study. Psychooncology. 2014;23(1):100-7.
Zhong T, Hu J, Bagher S, Vo A, O'Neill AC, Butler K, et al. A Comparison of Psychological Response, Body Image, Sexuality, and Quality of Life between Immediate and Delayed Autologous Tissue Breast Reconstruction: A Prospective Long-Term Outcome Study. Plast Reconstr Surg. 2016;138(4):772-80.
Beckmann J, Johansen L, Richardt C, Blichert-Toft M. Psychological reactions in younger women operated on for breast cancer. Amputation versus resection of the breast with special reference to body-image, sexual identity and sexual function. Dan Med Bull. 1983;30 Suppl 2:10-3.
Steinberg MD, Juliano MA, Wise L. Psychological outcome of lumpectomy versus mastectomy in the treatment of breast cancer. Am J Psychiatry. 1985;142(1):34-9.
Ganz PA, Lee JJ, Sim MS, Polinsky ML, Schag CA. Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. J Clin Epidemiol. 1992;45(5):473-85.
Yurek D, Farrar W, Andersen BL. Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. J Consult Clin Psychol. 2000;68(4):697-709.
Schain WS, d'Angelo TM, Dunn ME, Lichter AS, Pierce LJ. Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences. Cancer. 1994;73(4):1221-8.
Taylor KL, Lamdan RM, Siegel JE, Shelby R, Hrywna M, Moran-Klimi K. Treatment regimen, sexual attractiveness concerns and psychological adjustment among African American breast cancer patients. Psychooncology. 2002;11(6):505-17.
Arora NK, Gustafson DH, Hawkins RP, McTavish F, Cella DF, Pingree S, et al. Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: a prospective study. Cancer. 2001;92(5):1288-98.
Polivy J. Psychological effects of mastectomy on a woman's feminine self-concept. J Nerv Ment Dis. 1977;164(2):77-87.
Wolberg WH, Romsaas EP, Tanner MA, Malec JF. Psychosexual adaptation to breast cancer surgery. Cancer. 1989;63(8):1645-55.
Ashcroft JJ, Leinster SJ, Slade PD. Breast cancer--patient choice of treatment: preliminary communication. J R Soc Med. 1985;78(1):43-6.
Penman DT, Bloom JR, Fotopoulos S, Cook MR, Holland JC, Gates C, et al. The impact of mastectomy on self-concept and social function: a combined cross-sectional and longitudinal study with comparison groups. Women Health. 1986;11(3-4):101-30.
Goldberg JA, Scott RN, Davidson PM, Murray GD, Stallard S, George WD, et al. Psychological morbidity in the first year after breast surgery. Eur J Surg Oncol. 1992;18(4):327-31.
Holmberg L, Omne-Ponten M, Burns T, Adami HO, Bergstrom R. Psychosocial adjustment after mastectomy and breast-conserving treatment. Cancer. 1989;64(4):969-74.
Lee MS, Love SB, Mitchell JB, Parker EM, Rubens RD, Watson JP, et al. Mastectomy or conservation for early breast cancer: psychological morbidity. Eur J Cancer. 1992;28A(8-9):1340-4.
Littleton HL, Axsom D, Pury CL. Development of the body image concern inventory. Behav Res Ther. 2005;43(2):229-41.
Mohammadi N, Sajadinejad MS. The evaluation of psychometric properties of Body Image Concern Inventory and examination of a model about the relationship between body mass index, body image dissatisfaction and self-esteem in adolescent girls. Psychological Studies. 2007;3:85-101.
Devins GM, Binik YM, Hutchinson TA, Hollomby DJ, Barre PE, Guttmann RD. The emotional impact of end-stage renal disease: importance of patients' perception of intrusiveness and control. Int J Psychiatry Med. 1983;13(4):327-43.
Margolis GJ, Goodman RL, Rubin A, Pajac TF. Psychological factors in the choice of treatment for breast cancer. Psychosomatics. 1989;30(2):192-7.
Noyan MA, Sertoz OO, Elbi H, Kayar R, Yilmaz R. Variables affecting patient satisfaction in breast surgery: a cross-sectional sample of Turkish women with breast cancer. Int J Psychiatry Med. 2006;36(3):299-313.
Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92(17):1422-9.
Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study. Plast Reconstr Surg. 2003;111(3):1060-8.
Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem B, Morrow M, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14(6):1467-79.
Pusic A, Thompson TA, Kerrigan CL, Sargeant R, Slezak S, Chang BW, et al. Surgical options for the early-stage breast cancer: factors associated with patient choice and postoperative quality of life. Plast Reconstr Surg. 1999;104(5):1325-33.
Mock V. Body image in women treated for breast cancer. Nurs Res. 1993;42(3):153-7.
Reaby LL, Hort LK, Vandervord J. Body image, self-concept, and self-esteem in women who had a mastectomy and either wore an external breast prosthesis or had breast reconstruction and women who had not experienced mastectomy. Health Care Women Int. 1994;15(5):361-75.
Cocquyt VF, Blondeel PN, Depypere HT, Van De Sijpe KA, Daems KK, Monstrey SJ, et al. Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg. 2003;56(5):462-70.
den Heijer M, Seynaeve C, Timman R, Duivenvoorden HJ, Vanheusden K, Tilanus-Linthorst M, et al. Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study. Eur J Cancer. 2012;48(9):1263-8.
Levy J, Bosc R, Warren N, Rebecca S, Dao TH, Hersant B, et al. Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With a Deep Inferior Epigastric Perforator Flap: A Study of Patient Satisfaction. Ann Plast Surg. 2018;80(6):639-43.
Brandberg Y, Sandelin K, Erikson S, Jurell G, Liljegren A, Lindblom A, et al. Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study. J Clin Oncol. 2008;26(24):3943-9.
Gross E, Hannoun-Levi JM, Rouanet P, Houvenaeghel G, Teissier E, Ellis S, et al. [Evaluation of immediate breast reconstruction and radiotherapy: factors associated with complications]. Cancer Radiother. 2010;14(8):704-10.
Carnevale A, Scaringi C, Scalabrino G, Campanella B, Osti MF, De Sanctis V, et al. Radiation therapy after breast reconstruction: outcomes, complications, and patient satisfaction. Radiol Med. 2013;118(7):1240-50.
Hopwood P. The assessment of body image in cancer patients. Eur J Cancer. 1993;29A(2):276-81.
Juhl AA, Christensen S, Zachariae R, Damsgaard TE. Unilateral breast reconstruction after mastectomy - patient satisfaction, aesthetic outcome and quality of life. Acta Oncol. 2017;56(2):225-31.
Kaviani A, Mir M, Daryani A, Bonyadi M, Ebrahimi M, Neishaboury M, et al. Quality of Life after Breast Conservation versus Oncoplastic Surgery. Archives of Breast Cancer. 2015;2(2).
Kaviani A, Safavi A, Mohammadzadeh N, Jamei K, Ansari-Damavandi M, Salmon RJ. Oncoplastic surgery in breast conservation: a prospective evaluation of the patients, techniques, and oncologic outcomes. Am J Surg. 2014;208(5):727-34.
Deadman JM, Leinster SJ, Owens RG, Dewey ME, Slade PD. Taking responsibility for cancer treatment. Soc Sci Med. 2001;53(5):669-77.
Nicholson RM, Leinster S, Sassoon EM. A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. Breast. 2007;16(4):396-410.
Schmidt JL, Wetzel CM, Lange KW, Heine N, Ortmann O. Patients' experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction. Arch Gynecol Obstet. 2017;296(4):827-34.
Ng SK, Hare RM, Kuang RJ, Smith KM, Brown BJ, Hunter-Smith DJ. Breast Reconstruction Post Mastectomy: Patient Satisfaction and Decision Making. Ann Plast Surg. 2016;76(6):640-4.
Gopie JP, Mureau MA, Seynaeve C, Ter Kuile MM, Menke-Pluymers MB, Timman R, et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer. 2013;12(3):479-87.
Dauplat J, Kwiatkowski F, Rouanet P, Delay E, Clough K, Verhaeghe JL, et al. Quality of life after mastectomy with or without immediate breast reconstruction. Br J Surg. 2017;104(9):1197-206.
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