Impact of radiation therapy on breast satisfaction and health-related quality of life after breast reconstruction: a multicenter cross-sectional controlled study (Reborn study-02).

Abstract

Background: Post-mastectomy radiation therapy (PMRT) is essential for reducing recurrence in patients with high-risk breast cancer but may negatively impact breast reconstruction outcomes. The impacts of PMRT on breast satisfaction and health-related quality of life (HR-QOL) remain unclear, particularly in Japanese patients. We evaluated the impact of PMRT on breast satisfaction and HR-QOL using BREAST-Q.

Methods: A multicenter, cross-sectional study was conducted at 10 institutions in Japan. Patients who underwent breast reconstruction with or without PMRT were surveyed using the Japanese version of the BREAST-Q. Endpoints included breast satisfaction and HR-QOL domains (physical, psychosocial, and sexual well-being). Multivariate analysis was performed to identify factors influencing these outcomes.

Results: Overall, 1078 patients with primary breast cancer who underwent breast reconstruction were included in this study, with a questionnaire response rate of 77.0% (830/1,078). Data from 830 patients were analyzed (PMRT group: 214, non-PMRT group: 616). The PMRT group had significantly lower breast satisfaction (50.7 vs. 57.5, P < 0.001), physical well-being (70.2 vs. 82.4, P < 0.001), and psychosocial well-being (51.2 vs. 56.4, P < 0.001). There was no significant difference in sexual well-being. PMRT was a predictor of reduced breast satisfaction, physical well-being, and psychosocial well-being.

Conclusions: PMRT was associated with decreased breast satisfaction and HR-QOL in patients with reconstructed breasts. Patients should be given comprehensive information regarding the potential impacts of PMRT on breast satisfaction and HR-QOL. Shared decision-making based on realistic preoperative expectations is critical for optimal patient outcomes and satisfaction with treatment modalities.