Emanuele Cammarata, Federico Coppola, Giovanni Zabbia, Mara Franza, Salvatore Vieni, Calogero Cipolla, Adriana Cordova, Francesca Toia
Breast cancer remains the most commonly diagnosed cancer in women, with surgical intervention as a cornerstone treatment. Options include breast-conserving therapy (BCT) and mastectomy with or without post-mastectomy breast reconstruction (PMBR). This study aimed to compare quality of life (QoL) outcomes between breast-conserving therapy (BCT) and post-mastectomy breast reconstruction (PMBR), with either autologous DIEP flap or expander/prosthetic reconstruction. A single-institution retrospective study was conducted of 200 breast cancer patients treated from January 2016 to December 2021. Patients were divided into three groups: BCT, PMBR with DIEP flap, and implant-based PMBR. QoL and satisfaction were evaluated using the BREAST-Q questionnaire 12 months post-surgery. Statistical significance was assessed through ANOVA test, with statistically significance if p < 0.05. BCT was associated with significantly higher psychological well-being than prosthetic reconstruction (p < 0.0001), as was autologous reconstruction (p < 0.0044). Sexual well-being scores favored BCT over prosthetic reconstruction (p < 0.0001) and autologous over prosthetic reconstruction (p < 0.0001). Physical well-being scores were also significantly higher in the BCT and DIEP groups than in the prosthetic group. While satisfaction with care showed no significant differences across groups, DIEP flap reconstruction exhibited comparable, and in some cases superior, scores in relation to BCT. BCT and DIEP flap reconstruction are associated with improved psycho-physical and psycho-social outcomes compared to prosthetic reconstruction. When feasible, DIEP flap reconstruction may be associated with the best QoL outcomes after mastectomy. However, further large-scale studies are recommended to confirm these findings and enhance decision-making for optimal patient-centered care.