Breast-Conserving Therapy Versus Postmastectomy Breast Reconstruction: Propensity Score-Matched Analysis

Area of Science:

• Oncology
• Surgical Oncology
• Patient-Reported Outcomes Research

Background:

• Direct comparison of patient-reported outcomes (PROs) between breast conserving-therapy (BCT) and postmastectomy breast reconstruction (PMBR) is often confounded by treatment variations.
• Propensity score-matching analysis is utilized to enable a more direct comparison of PROs between BCT and PMBR.

Purpose of the Study:

• To compare patient-reported outcomes (PROs) between breast conserving-therapy (BCT) and postmastectomy breast reconstruction (PMBR) using propensity score-matched analysis.
• To identify differences in quality of life, satisfaction, and well-being between BCT and PMBR patients over time.

Main Methods:

• Utilized propensity score-matching to compare 2616 unique patients (BCT vs. PMBR) from 2010-2022.
• Collected PROs using the BREAST-Q across multiple time points: preoperatively, 6 months, and 1, 2, and 3 years postoperatively.
• A 4-point difference in BREAST-Q domains was considered clinically meaningful.

Main Results:

• At 6 months postoperatively, BCT patients reported significantly higher scores across all BREAST-Q domains compared to PMBR patients.
• From 1 to 3 years postoperatively, BCT patients consistently demonstrated superior Satisfaction With Breasts, Psychosocial Well-Being, and Sexual Well-Being.
• These differences in key PRO domains were clinically meaningful, exceeding the 4-point threshold.

Conclusions:

• Breast conserving-therapy (BCT) is associated with superior patient-reported outcomes (PROs) compared to postmastectomy breast reconstruction (PMBR) in the early postoperative period and up to three years.
• Given the comparable survival and recurrence rates, patients eligible for both procedures should be informed about the advantages of BCT regarding PROs.
• This study provides statistically powered evidence supporting BCT for better long-term quality of life and patient satisfaction.