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Updated: Oct 26, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Quality of life assessment using BREAST-Q and RAND-36 after mastectomy alone compared with subpectoral breast
J E van der Veen1, E Visser2, A A Hendrickx3
1Department of Plastic surgery, Frisius Medical Centre, Leeuwarden, the Netherlands; Department of Plastic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
Background:
Mastectomy can negatively affect health-related quality of life (HR-QoL). Subpectoral breast reconstruction can be performed to restore breast contour and may help improve HR-QoL. We aimed to evaluate the long-term impact of mastectomy alone compared with subpectoral breast reconstruction.
Materials And Methods:
This prospective multicentre study included patients who underwent mastectomy between 2016 and 2019. Patients were divided into two groups: mastectomy alone and subpectoral breast reconstruction. HR-QoL was assessed preoperatively and at 1 and 2 years postoperatively using the BREAST-Q and RAND-36 questionnaires. Linear mixed models were used to analyse changes over time and differences between the groups.
Results:
A total of 156 patients were included; among them, 61 (39%) underwent reconstruction. Satisfaction with breast(s) domain scores improved 2 years postoperatively in the reconstruction group, resulting in a significant difference between the groups (M: 43.6±4.9 vs R: 58.4±4.7, P=0.01). They also reported a significant decline in sexual well-being (70.1±4.3 vs 58.2±4.6, P=0.002) and physical well-being (83.3±3.0 vs 75.3±3.0, P<0.001) at 1 year postoperatively. Contrastingly, outcomes in the mastectomy group continued to be stable over time. Scores in psychosocial well-being did not differ over time in the groups. RAND-36 outcomes showed an increase in pain and reduced physical functioning in the reconstruction group 1 year postoperatively, with partial recovery at 2 years, resulting in no significant differences between the groups.
Conclusion:
Our results demonstrated that subpectoral breast reconstruction was associated with higher breast satisfaction but lower physical and sexual well-being. These findings highlight the need for individualised counselling regarding the potential benefits and trade-offs of subpectoral reconstruction. Therefore, discussing the patients' expectations is essential to facilitate shared decision-making.