Objective: National rates of breast reconstruction are low, characterized by large racial and geographical variations in use. These disparities raise concern of an unmet need in vulnerable patient populations. However, our understanding of the impact of reconstruction on patients' long-term quality of life (QOL) is poor. Few studies directly compare patient-reported outcomes between the reconstructed and the unreconstructed mastectomy populations and even fewer look at long-term outcomes. Our goal was to evaluate the impact of reconstruction on patients' QOL during the cancer survivorship period.

Methods: A cross-sectional self-administered questionnaire was given to University of Michigan patients who were diagnosed with breast cancer between 1977 and 2006 (response rate 70%). Our sample included 144 unreconstructed and 225 reconstructed patients. Using validated measures, patients scored their general QOL on a scale from 0-100. They then scored their breast-related QOL on a 5-point Likert scale for the following domains: psychosocial status, physical and sexual function. Scores were dichotomized into positive and negative responses, and chi-square and t-tests were used for the analyses. Multiple logistic regression was used to determine the correlation between QOL and receipt of reconstruction, while controlling for patient age, receipt of chemotherapy and radiation therapy, history of recurrence, time after mastectomy, and presence of major medical co-morbidities.

Results: Mean follow-up time after mastectomy was 7.6 years (range 3 – 30 years). Overall QOL scores were high (unreconstructed patient mean 82.4, SD 18.2; reconstructed patient mean 83.6, SD 18.1) and no significant differences were found between the two groups in regards to general QOL. However, receipt of reconstruction did appear to affect breast-specific QOL. When asked how their life is now, compared to before having their breast surgery, patients with breast reconstruction were better off emotionally (OR 2.9, p < 0.01), physically (OR 3.3, p < 0.01), and sexually (OR 6.3, p < 0.01) compared to those without reconstruction.

Conclusions: Long-term self-reported general QOL is high in both the unreconstructed and reconstructed breast cancer populations, suggesting that women adapt well in the survivorship period. However, receipt of breast reconstruction is associated with higher breast-related QOL, specifically in regards to emotional, physical and sexual well-being. These valuable data suggest that an unmet need may exist for women who desire breast reconstruction but have limited access to these procedures. There may be a critical need for improved advocacy for breast reconstruction for these women.