The present study comprised a final sample of 53 women with reconstructed breasts and 28 women with nonreconstructed breasts. These women had a mean age of 48.5 years (SD = 9.9 years), and the most frequent age group was 40 to 50 years (35.8%). Of all women interviewed, five had bilateral mastectomy, three were reconstructed, and two were not. A total of 45.7% of them finished high school, 50.6% were single, and 65.4% had an income of less than or equal to one Brazilian minimum wage (BM), which is equivalent to approximately 250 dollars. Among those surveyed, 45.0% considered their own health as "good," and 54.3% reported not having comorbidities. When comparing the epidemiological characteristics of reconstructed and nonreconstructed patients, the groups were similar and there were no statistically expressive differences in the WHOQOL scores.
The average length of time of the application of the questionnaire after breast surgery was 3.8 years (SD = 3.2 years) for mastectomy and 2.5 years (SD = 1.1 years) for breast reconstruction.
Considering the women who were reconstructed, 47.2 % (n=25) were single, 67.9% (n = 36) were reconstruct immediately after mastectomy, at a mean age of 47.5 years (SD = 9.7), and 32.1% bilaterally, at a mean age of 51.4 years (SD = 10). Some 43.4% of reconstructions were done with subpectoral silicone implants, 35.8% with myocutaneous flaps of the latissimus dorsi muscle with breast implants, 11.3% with subpectoral tissue expanders, 5.7% with the transverse rectus abdominis flap (TRAM flap), and 3.8% with another type of reconstruction.
The average length of hospital stay among women who had mastectomy was 2.5 days (SD = 2.3 days), while the average length of hospital stay after breast reconstruction was 2.7 days (SD = 2.5 days). Among the 28 women who did not undergo breast reconstruction, 53.6% (15) were single, and 13 (46.4%) reported not wanting to reconstruct.
The QOL between the reconstructed patients and nonreconstructed patients were not significant, and the differences between patients with late and immediate reconstruction were also not statistically significant.
It is noteworthy that 77.4% (n= 41) of the women who had breast reconstruction did undergo radiation therapy, against 57% (n=16) of the women without breast reconstruction. The QOL measurements among patients who underwent neoadjuvant and / or adjuvant therapies with radiotherapy and chemotherapy, did not show statistically significant differences (Table 1).
Table 1 - Clinical, socioeconomic, and treatment characteristics of patients related to the quality of life of 81 patients subjected to treatment for breast cancer.
|
Breast
Reconstruction
|
WHOQOL
|
Yes
n
|
No
n
|
Physical
Mean (SD)
|
Psychological
Mean (SD)
|
Social Relations
Mean (SD)
|
Environment
Mean (SD)
|
General
Mean (SD)
|
Age Group,
Mean (SD)
|
47.5
(9.7)
|
51.4
(10)
|
|
|
|
|
|
0.161 W
|
<40
|
13
|
2
|
62.29 (11.02)
|
70.67 (11.9)
|
77.78 (13.25)
|
63.67 (13.56)
|
66.78 (9.68)
|
40-50
|
22
|
7
|
66.11 (13.24)
|
72.64 (9.73)
|
71.03 (16.06)
|
65.09 (8.36)
|
68.02 (8.88)
|
50-60
|
17
|
9
|
65.82 (10.49)
|
72.05 (9.38)
|
70.26 (18.59)
|
64..42 (11.19)
|
67.47 (9.59)
|
>60
|
7
|
4
|
63.12 (9.77)
|
66.67 (14.68)
|
64.85 (14.01)
|
60.91 (12.11)
|
63.48 (9.16)
|
p-value
|
0.426 Q
|
0.682 k
|
0.679 k
|
0.253 k
|
0.660 k
|
0.461k
|
Educational Level
|
|
|
|
|
|
|
|
Until elementary school
|
22
|
12
|
62.77 (10.72)
|
70.59 (11.59)
|
67.25 (17.7)
|
64.63 (12.75)
|
65.91 (9.83)
|
Until high school
|
29
|
8
|
65.25 (11.52)
|
70.81 (10.35)
|
72.97 (15.23)
|
62.91 (9.42)
|
66.82 (8.96)
|
Until graduation or superior
|
8
|
2
|
70.86 (12.62)
|
75.33 (9.58)
|
78 (13.35)
|
66.25 (8.19)
|
71.33 (7.6)
|
p-value
|
0.373 Q
|
0.330 k
|
0.399 k
|
0.126 k
|
0.464 k
|
0.216 k
|
Marital status
|
|
|
|
|
|
|
|
Single
|
25
|
15
|
64.07 (11.89)
|
70..25 (11.99)
|
71 (16.64)
|
65.31 (11.95)
|
66.9 (10.34)
|
Not single
|
28
|
13
|
65.71 (11.12)
|
72.28 (9.5)
|
71.38 (16.28)
|
62.8 (9.46)
|
67.09 (8.15)
|
p-value
|
0.352 Q
|
0.537 w
|
0.582 w
|
0.875 w
|
0.234 w
|
0.857 w
|
How is your health?
|
|
|
|
|
|
|
|
Weak
|
2
|
0
|
57.14 (8.08) a.b
|
65.00 (7.07) a.b
|
43.33 (14.41) b
|
51.25 (1.77) a.b
|
55.42 (2.95) b
|
Not bad, not good
|
16
|
9
|
58.17 (8.24) b
|
63.47 (10.43) b
|
64.27(17.41) a,b
|
58.80 (9.69) b
|
60.47 (7.99) b
|
Good
|
25
|
11
|
68.49 (9.43) a
|
75.19 (9.74) a
|
74.44 (11.76) a
|
67.36 (10.42) a
|
70.53 (7.88) a
|
Very good
|
15
|
2
|
68.07 (15.46) a
|
75.1 (7.56) a
|
76.08 (17.17) a
|
65.29 (9.76) a
|
69.90 (8.29) a
|
p-value
|
0.268 Q
|
0.002 k
|
<0.001 k
|
0.016 k
|
0.002 k
|
<0.001 k
|
Comorbidities,
|
|
|
|
|
|
|
|
Yes
|
23
|
14
|
64.48 (12.48)
|
70.00 (13.26)
|
68.65 (18.85)
|
63.78 (11.94)
|
66.15 (11.00)
|
No
|
36
|
8
|
65.26 (10.67)
|
72.35 (8.35)
|
73.33 (13.79)
|
64.26 (9.80)
|
67.71 (7.51)
|
p-value
|
0.048 Q
|
0.661 w
|
0.721 w
|
0.181 w
|
0.830 w
|
0.605 w
|
Family income
|
|
|
|
|
|
|
|
Até 1 BM
|
40
|
13
|
63.67 (11.11)
|
69.94 (10.28)
|
70.44 (16.36)
|
62.5 (11.27)
|
65.69 (9.22)
|
De 1 a 2 BM
|
12
|
6
|
65.08 (8.69)
|
72.78 (11.90)
|
72.59 (17.84)
|
65.97 (10..71)
|
68.24 (9)
|
>2 BM
|
7
|
3
|
71.14 (16.13)
|
75.67 (10.89)
|
72.67 (14.89)
|
68.75 (5.8)
|
71.67 (8.8)
|
p-value
|
0.751 Q
|
0.540 k
|
0.131 k
|
0.549 k
|
0.093 k
|
0.117 k
|
Mastectomy technique
|
|
|
|
|
|
|
|
Skin and ANC non-sparing
|
26
|
25
|
65.71 (10.84)
|
71.31 (11.51)
|
71.37 (17.35)
|
63.14 (10.12)
|
66.96 (9.12)
|
Skin sparing
|
15
|
3
|
65.4 (10.18)
|
71.67 (11.04)
|
73.7 (13.03)
|
66.11 (12.4)
|
68.24 (9.57)
|
Skin and ANC sparing
|
10
|
0
|
60.29 (15.68)
|
71.33 (6.32)
|
64 (16.09)
|
64 (9.66)
|
64.75 (8.53)
|
Other
|
2
|
0
|
62.86 (20.2)
|
66.67 (14.14)
|
80 (18.86)
|
68.75 (22.98)
|
67.92 (19.45)
|
p-value
|
|
0.509 k
|
0.921 k
|
0.471 k
|
0.557 k
|
0.755 k
|
Breast reconstruction,
|
|
|
|
|
|
|
|
Yes
|
|
|
65.62 (11.74)
|
71.69 (9.97)
|
72.77 (15.82)
|
64.62 (10.88)
|
67.7 (9.02)
|
No
|
|
|
62.99 (10.71)
|
70.15 (12.91)
|
66.97 (17.39)
|
62.5 (10.55)
|
65.11 (9.76)
|
p-value
|
|
|
0.536 w
|
0.616 w
|
0.166 w
|
0.343 w
|
0.310 w
|
Neoadjuvant therapy
|
|
|
|
|
|
|
|
Chemotherapy
|
30
|
8
|
63.68 (12.12)
|
71.4 (11)
|
71.4 (16.18)
|
64.54 (11.36)
|
66.86 (9.22)
|
Chemotherapy and Radiotherapy
|
2
|
1
|
81.9 (19.02)
|
71.11 (18.36)
|
71.11 (3.85)
|
61.67 (8.78)
|
71.11 (13.39)
|
None
|
27
|
13
|
64.79 (9.38)
|
71.17 (10.31)
|
71 (17.32)
|
63.75 (10.52)
|
66.81 (9.16)
|
p-value
|
0.509 Q
|
0.230 k
|
0.935 k
|
0.991 k
|
0.809 k
|
0.704 k
|
Adjuvant therapy
|
|
|
|
|
|
|
|
Chemotherapy
|
9
|
2
|
62.6 (6.32)
|
71.52 (8.35)
|
70.3 (10.05)
|
64.77 (7.54)
|
66.52 (6.08)
|
Radiotherapy
|
24
|
6
|
64.29 (12.53)
|
71.44 (12.43)
|
72.44 (16.49)
|
64.08 (11.83)
|
67.03 (10.03)
|
Chemotherapy and radiotherapy
|
17
|
10
|
65.71 (12.45)
|
71.36 (11.26)
|
70.12 (19.16)
|
63.61 (12.45)
|
66.98 (10.69)
|
None
|
9
|
4
|
66.59 (10.84)
|
70.51 (8.26)
|
71.28 (15.49)
|
64.23 (7.1)
|
67.37 (6.88)
|
p-value
|
0.450 Q
|
0.687 k
|
0.957 k
|
0.981 k
|
0.894 k
|
0.993 k
|
Reconstruction technique
|
|
|
|
|
|
|
|
TRAM flap
|
3
|
|
74.29 (17.38)
|
76.67 (6.67)
|
62.22 (25.24)
|
65 (10.9)
|
70.28 (11.82)
|
Myocutaneous flaps of the Latissimus Dorsi Muscle with breast implants
|
19
|
|
66.57 (8.7)
|
73 (10.7)
|
79 (16.08)
|
66.5 (11.65)
|
69.71 (8.29)
|
Subpectoral silicone implants
|
23
|
|
63.81 (12.83)
|
70 (9.56)
|
69.14 (12.56)
|
63.61 (9.94)
|
65.96 (8.4)
|
Subpectoral tissue expanders
|
6
|
|
66.94 (12.33)
|
73.81 (10.44)
|
71.43 (19.52)
|
61.79 (11.25)
|
67.5 (11.1)
|
Another tecnique
|
2
|
|
62.86 (20.2)
|
66.67 (14.14)
|
80 (18.86)
|
68.75 (22.98)
|
67.92 (19.45)
|
p-value
|
|
|
0.646 k
|
0.721 k
|
0.203 k
|
0.751 k
|
0.635 k
|
Momento of breast reconstruction,
|
|
|
|
|
|
|
|
Immediate
|
36
|
|
63.83 (12.35)
|
70.24 (10.31)
|
73.01 (15.2)
|
64.82 (11.34)
|
66.91 (9.67)
|
Delayed
|
17
|
|
69.68 (9.3)
|
75 (8.5)
|
72.22 (17.6)
|
64.17 (10.04)
|
69.49 (7.26)
|
Nonreconstruction
|
28
|
|
62.99 (10.71)
|
70.15 (12.91)
|
66.97 (17.39)
|
62.5 (10.55)
|
65.11 (9.76)
|
p-value
|
|
|
0.084 k
|
0.228 k
|
0.382 k
|
0.611 k
|
0.327 k
|
Complications,
|
|
|
|
|
|
|
|
Mastectomy
|
|
6
|
54.76 (9.97) a
|
65.71 (12.87)
|
61.9 (23.32)
|
59.29 (9.97)
|
59.76 (10.84)
|
Immediate reconstruction
|
17
|
|
64.87 (13.54) a.b
|
69.17 (5.56)
|
65.83 (9.72)
|
60.94 (7.06)
|
64.69 (6.41)
|
Delayed reconstruction
|
7
|
|
73.88 (9.82) b
|
73.33 (8.82)
|
68.89 (7.7)
|
55.83 (10.1)
|
63.06 (9.18)
|
None
|
29
|
22
|
64.87 (10.32) a.b
|
73.06 (10.58)
|
75.56 (19.56)
|
66.88 (11.97)
|
71.18 (10.14)
|
p-value
|
|
0.017 k
|
0.248 k
|
0.539 k
|
0.792 k
|
0.359 k
|
Note: SD - standard deviation; N-absolute frequency; WMann-Whitney test; KKruskal-Wallis test; QPearson's chi-square test; TRAM flap - transverse rectus abdominis flap; BM- Brazilian minimum wage. The variables in bold had statistically significant values (p <0.05).
The longer hospitalization time after mastectomy had a significant negative correlation with the scores WHOQOL-bref in the physical, psychological, and general domains (ρ = -0.259; p = 0.020). Longer hospitalization time after breast reconstruction had a negative impact in the psychological domain (ρ = -0.301; p = 0.023) and the number of radiation therapy sessions had no impact on scores of physical, psychological, social relations and general (Table 2).
Table 2 - Correlations between duration of surgical treatment, number of adjuvant radiotherapy sessions, length of hospital stay after surgery, and perception of quality of life and health and the WHOQOL-bref questionnaire scores.
|
WHOQOL
|
|
Physical
Mean (SD)
|
Psychological
Mean (SD)
|
Social Relations
Mean (SD)
|
Environment
Mean (SD)
|
General
Mean (SD)
|
Time after mastectomy
|
0.063 (0.582)
|
-0.006 (0.96)
|
-0.071 (0.529)
|
-0.107 (0.344)
|
-0.031 (0.783)
|
Time after reconstruction
|
-0.066 (0.619)
|
-0.093 (0.479)
|
-0.133 (0.312)
|
-0.071 (0.589)
|
-0.094 (0.473)
|
Adjuvant radiotherapy sessions
|
0.076 (0.498)
|
0.078 (0.490)
|
0.035 (0.756)
|
-0.085 (0.451)
|
0.046 (0.684)
|
Hospitalization time after mastectomy
|
-0.293 (0.008)
|
-0.325 (0.003)
|
-0.092 (0.414)
|
-0.075 (0.508)
|
-0.259 (0.020)
|
Hospitalization time after reconstruction
|
-0.141 (0.295)
|
-0.301 (0.023)
|
0.028 (0.838)
|
0.074 (0.585)
|
-0.101 (0.456)
|
Perception of quality of life
|
0.492 (<0.001)
|
0.477 (<0.001)
|
0.357 (0.001)
|
0.489 (<0.001)
|
0.571 (<0.001)
|
Perception of health
|
0.404 (<0.001)
|
0.54 (<0.001)
|
0.256 (0.021)
|
0.502 (<0.001)
|
0.542 (<0.001)
|
Note: P - Spearman correlation. The variables in bold had statistically significant values (p <0.05).
Regarding satisfaction with the operated breast, Table 3 shows that the desire of the woman to undergo breast reconstruction but for some reason being prevented from undergoing it was associated with a lower score on the physical domain (ρ = -0.654; p = 0.029), the social relationship domain (ρ = -0.643; p = 0.033), and the overall WHOQOL-bref (ρ = -0.673; p = 0.023).
Within the group of reconstructed patients, we found that the patients who had greater satisfaction with their breasts had higher the psychological domain score (ρ = 0.419; p = 0.002) and higher overall QOL score (ρ = 0.300; p = 0.029).
The satisfaction of patients with their operated breasts, whether reconstructed or not reconstructed, had a positive impact in the psychological domain (ρ = 0.375; p = 0.001), in social relationships (ρ = 0.286; p = 0.010), in environment (ρ = 0.289; p = 0.009) and the overall WHOQOL-bref (ρ = 0.317; p = 0.004) (Table 3).
Table 3 - Satisfaction regarding the operated breast between reconstructed and nonreconstructed patients and the correlation with the WHOQOL-bref.
|
WHOQOL
|
|
Physical
Mean (SD)
|
Psychological
Mean (SD)
|
Social Relations
Mean (SD)
|
Environment
Mean (SD)
|
General
Mean (SD)
|
Satisfaction of patients with their operated breasts
|
|
|
|
|
|
Total
|
0.189 (0.090)
|
0.375 (0.001)
|
0.286 (0.010)
|
0.289 (0.009)
|
0.317 (0.004)
|
With breast reconstruction
|
0.231 (0.097)
|
0.419 (0.002)
|
0.185 (0.184)
|
0.181 (0.195)
|
0.300 (0.029)
|
Nonreconstructed but desired it
|
-0.654 (0.029)
|
-0.462 (0.153)
|
-0.643 (0.033)
|
-0.071 (0.835)
|
-0.673 (0.023)
|
Non reconstructed and don’t desired it.
|
0.373 (0.210)
|
0.486 (0.093)
|
0.504 (0.079)
|
0.297 (0.324)
|
0.487 (0.091)
|
ANCOVA
|
0.054
|
0.036
|
0.025
|
0.500
|
0.023
|
Note: P - Spearman correlation. ANCOVA – Analysis of covariance. The variables in bold had statistically significant values (p <0.05).