Impact of Breast Cancer Surgery on Physical Well-Being of the Chest: A Longitudinal BREAST-Q Study

Breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR) offer similar oncologic outcomes in early-stage breast cancer, leading patients to base decisions on nononcologic factors such as chest wall discomfort, tightness, and functional limitations. The authors' primary objective was to evaluate the effects of these operations on quality of life using the BREAST-Q Physical Well-Being: Chest subscale. The secondary objective was to assess the impact of different radiation regimens on chest physical well-being.

A retrospective review of stage 0 to III breast cancer patients who underwent BCS, MA, or IBR from 2015 to 2019 was conducted. The primary outcome was change in Physical Well-Being: Chest BREAST-Q scores from the preoperative period to 1-year postoperatively. A minimal important difference greater than or equal to 4 points indicated clinical significance.

Of 517 patients, 202 underwent BCS, 125 underwent MA, and 190 underwent IBR. BCS patients demonstrated the highest decline of 15.3 points (89.1 to 73.8; P < 0.001) followed by MA with 12.7 points (76.6 to 63.9; P < 0.001). IBR had the smallest decline of 3.7 points (78.0 to 74.3; P = 0.022). A total of 262 radiation patients experienced a mean decline of 15.2 points (84.6 to 69.4; P < 0.001), with the regional node irradiation with boost group exhibiting the greatest decline of 21.5 points (88.5 to 67.0; P < 0.001).

BCS patients, despite higher baseline scores, experienced the greatest decline, whereas IBR patients had the smallest. In addition, greater radiation intensity and extent correlated with larger declines. Integrating minimal important difference into clinical practice ensures that patient-reported outcomes capture changes that are meaningful to patients, guiding treatment decisions.