Younger breast cancer patients who underwent mastectomy reported lower breast satisfaction and poorer psychosocial and sexual well-being compared with those who underwent breast-conserving surgery, according to results of a trial presented at the 2018 San Antonio Breast Cancer Symposium, held Dec. 4–8.

"Historically, about 75% of women are eligible for breast-conserving surgery. However, over time, more women, and particularly young women, are electing for bilateral mastectomy," said the study's lead author, Laura S. Dominici, MD, FACS, a surgeon at Dana-Farber/Brigham and Women's Cancer Center, assistant professor of surgery at Harvard Medical School, and Division Chief of Breast Surgery at Brigham and Women's Faulkner Hospital. She said multiple factors influence women's decisions, but from an oncologic standpoint, the results are often equivalent.

"Women are becoming increasingly involved in the decision-making process, so we must make sure that they have as much information as possible about long-term outcomes, including quality of life," Dominici added.

In this study, Dominici and colleagues compared quality of life outcomes in young women across three different surgeries: breast-conserving surgery, unilateral mastectomy, and bilateral mastectomy. Between October 2016 and November 2017, Dominici and colleagues administered the BREAST-Q, a validated patient-reported outcomes survey, to 560 women diagnosed with breast cancer by age 40 who were enrolled in a large prospective cohort study. Among the women, 28% had breast-conserving surgery, and 72% had mastectomy. Among those who had a mastectomy, 72% of those were bilateral mastectomies. Eighty-nine percent of the women had had reconstructive surgery.

Dominici added that further research could provide more information to clinicians as they advise patients of their options for breast cancer surgery. "In the future, I am hopeful that we will be able to predict quality of life outcome for an individual patient following the different types of surgery in order to help her decide what is best for her," she said.

Dominici said the study's primary limitation is that it was not randomized, and it evaluated quality of life only at a single time point. She added that researchers did not have information about women's quality of life prior to the study, which could have affected their decision making and their post-surgery quality of life.

This study was funded by the Agency for Healthcare Research and Quality, Susan G. Komen, the Breast Cancer Research Foundation, and The Pink Agenda. Dominici declares no conflicts of interest.