Health-related quality of life following mastectomy and lumpectomy evaluated with the BREAST-Q and RAND-36

INTRODUCTION: Breast cancer surgery typically involves mastectomy or lumpectomy, both of which may affect health-related quality of life (HR-QoL). This study aimed to evaluate the long-term effects of mastectomy compared to lumpectomy on HR-QoL. MATERIALS AND METHODS: This prospective multicenter study included patients undergoing mastectomy or lumpectomy between 2016 and 2019. HR-QoL was assessed preoperatively, and at one and two years postoperatively using the BREAST-Q and RAND-36 questionnaire. Linear mixed models were used to analyze changes over time and differences between groups. RESULTS: A total of 480 patients were included: 385 (80.2%) underwent lumpectomy and 95 (19.8%) mastectomy. BREAST-Q satisfaction with breast(s) scores in the lumpectomy group increased significantly, from 62.2 ± 2.3 at baseline to 73.2 ± 2.4 two years postoperatively (P < 0.001). In the mastectomy group, scores improved at one year and no further increase was seen between one and two years follow-up. Physical well-being scores remained stable over time following mastectomy, whereas a significant improvement was observed after lumpectomy between one and two years (75.9 ± 1.5 vs 79.7 ± 1, P < 0.001). Both groups demonstrated significant improvement over time in the RAND-36 health change and social functioning. No significant differences were found between the groups for psychosocial well-being, sexual well-being or any of the RAND-36 domains. CONCLUSIONS: Long-term HR-QoL outcomes were largely comparable between patients undergoing lumpectomy and mastectomy. The only consistent difference was the higher BREAST-Q satisfaction with breasts scores observed in the lumpectomy group. As overall HR-QoL remained largely comparable between groups, treatment decisions should first be guided by oncological safety. Within these oncological boundaries, shared decision-making should incorporate patient preferences, recovery expectations, and the potential need for additional treatments or breast reconstruction.