Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction
Introduction
The loss of a breast after mastectomy has significant psychological and sexual implications 1, 2, 3. Although an external breast prosthesis may mask breast loss to the outside world, it is never incorporated into a woman's body image and does not always help her address the sense of deformity.
Because breast conserving surgery (BCS) leaves a women's body image intact; it may convey advantages over mastectomy in terms of body image, although previous studies 4, 5, 6, 7, 8 have failed to show significant psychological and sexual benefits of BCS over mastectomy. Breast reconstruction (BR) often represents another acceptable option for women who require mastectomy [9].
In the Nottingham Breast Unit, three primary treatment options have been used for patients with operable breast cancer; they are (i) wide local excision; simple mastectomy; and (iii) breast reconstruction immediate or delayed, often using subcutaneous mastectomy.
In this study, we compared patient satisfaction with cosmetic outcome and the psychosocial morbidity between the three different operative procedures.
Section snippets
Patients and methods
A series of 630 consecutive patients who remained disease-free following surgery for primary breast cancer were approached to take part in this study as part of their routine follow-up visit to the clinic. 577 (92%) patients agreed and completed the questionnaires: 254 (44%) women had wide local excision, 202 (35%) simple mastectomy and 121 (21%) breast reconstruction. They were seen postoperatively between June 1997 and October 1998. The follow-up was 39.5 months (range: 2–203 ) for wide local
Satisfaction
When patients were asked: How satisfied are you with the cosmetic result of your operation? 230 (91%) of the wide local excision were very much or moderately satisfied with the cosmetic outcome compared with 97 (80%) of the breast reconstruction group and 147 (73%) of the simple mastectomy group (Table 2). There was a significant difference between the three procedures in favour of wide local excision, with the exception of Age Group 1 and details of patient satisfaction in each age group are
Discussion
BCS for the treatment of primary breast cancer has been a goal of surgeons and radiotherapists for some time and is now regarded as an appropriate therapy 13, 14. Early comparisons of BCS with mastectomy did not demonstrate major psychological advantages. However, more recently, we reported our cosmetic results [15] and patient satisfaction [16] following wide local excision in separate reports, and showed that the psychological outcome was better among patients with a better cosmesis [17].
The
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