Abstract
BACKGROUND: Surgical decision-making for breast cancer requires consideration of both treatment outcomes and health-related quality of life (HR-QoL). However, data on HR-QoL differences across surgical procedures remain limited. This study compared breast satisfaction and HR-QoL among Japanese patients with breast cancer undergoing mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR). METHODS: A survey using the Japanese version of the BREAST-Q was conducted among patients with primary breast cancer who underwent surgery between August 2013 and July 2021. RESULTS: Of 648 patients, 577 were included in this study. The median time from surgery to questionnaire completion was 56 months. Satisfaction with breast scores was highest in patients undergoing BCS, followed by those undergoing IBR and MT. Psychosocial and sexual well-being were significantly better in patients undergoing BCS and IBR than in those undergoing MT, whereas physical well-being showed no significant differences among the three groups. In multiple regression analysis, surgical procedure was identified as the most influential factor for breast satisfaction, psychosocial well-being, and sexual well-being. CONCLUSIONS: This multicentre Japanese study confirmed that the choice of surgical procedure is the most influential factor affecting postoperative HR-QoL, with both BCS and IBR offering advantages over MT. The findings highlight the importance of comprehensive preoperative counselling to ensure patients receive detailed information on potential HR-QoL differences.