When we analyzed the quality of life of women who underwent mastectomy with breast reconstruction, no significant difference was observed compared to mastectomized women without breast reconstruction. This result corroborates the data of a meta-analysis published in 2009, all high-quality studies in that meta-analysis found quality of life, body image, or sexual image equivalent or worse in women who underwent mastectomy with reconstruction compared with women who underwent mastectomy only.12 However, when we analyzed the quality of life of nonreconstructed mastectomized women who wished to reconstruct their breasts, we found that nonreconstruction showed a significant negative correlation with general quality of life, as well as in the physical and social relationships domains. Based on these data, we believe that although the group of women who undergo breast reconstruction do not have significant differences in the quality of life compared to nonreconstructed women, nonreconstruction can negatively impact the quality of life when these women express the desire to reconstruct.
The satisfaction with the operated breast of the reconstructed patients also had a positive correlation with general quality of life, with a higher correlation in the psychological domain. Matthews et al. (2017) showed that women with greater psychological well-being were more likely to report greater satisfaction with the appearance of the breast, and satisfaction with the appearance of the breast promoted greater psychosocial well-being.14 The results of this study and those of Matthews et al.13 indicate that satisfaction with the reconstructed breast is an important factor for a better quality of life, especially when considering the psychological aspect; and although the other domains, physical, social relations, and environment, did not have significant correlations, the direction of the effects on them was positive.
In the present study, satisfaction with the operated breast was correlated with quality of life whether the patient underwent breast reconstruction or not. These data may be linked to personal feelings for or against reconstruction or individual motivations, such as the desire to regain their femininity, improve their body image, or avoid additional surgery.14,15,16
Comparing the quality of life of women with immediate vs. late reconstruction, we did not find significant differences in quality of life scores, but we found that the mean of the physical domain was the mean that had the greatest difference between these women. In contrast, Zhong et al. (2016) showed that mastectomy with immediate breast reconstruction can protect breast cancer patients from a period of psychosocial suffering, dissatisfaction with body image, and dissatisfaction with sexual life compared with those who underwent late reconstruction.17
Dauplat et al. (2017), in a multicenter study, using another instrument for analysis of quality of life, found that mastectomy followed by reconstruction preserved the quality of life, but only if reconstruction was proposed for certain types of patients, such as young age, among others.19 In our study, most of the reconstructed women underwent immediate reconstruction, they were over 40 years, so age could have been a negative impact factor. However, women with late reconstruction, whose mean age was greater than 50 years, reported better scores in the physical, psychological, and general domains. Dauplat18 argued that younger patients are also more concerned with their femininity, but this trend could not be verified in our study.
Patients with longer hospitalization time after mastectomy had lower WHOQOL-bref scores in the physical, psychological, and general domains. Longer hospitalization time after breast reconstruction had a negative impact only on the psychological domain. These data are interesting because although the event occurred in the past, it still has an impact on the quality of life of these women, especially in the psychological setting.
Our results may converge with those of Colakoglu et al., they found that women who had complications had lower aesthetic satisfaction compared to patients who did not. When analyzed by the time of complication onset, patients with early complications had significantly lower aesthetic satisfaction scores than patients without complications.19