Patient-reported cosmetic satisfaction and decision regret after breast conservation or mastectomy in older Chinese breast cancer patients

Abstract

Background: Few studies have investigated the optimal surgical management in older breast cancer patients, with many older patients opting for a mastectomy for simplicity’s sake. The aim of this study was to compare the patient-reported cosmetic satisfaction and decision regret between breastconserving surgery (BCS) and mastectomy in older Chinese patients. Methods: Female Chinese patients equal to or older than 70 years of age at breast cancer diagnosis were recruited prospectively between September 2019 to June 2021. A questionnaire was administered to patients who were eligible for a BCS or mastectomy. Satisfaction of breast cosmesis was measured preoperatively and postoperatively at six months with the Chinese version of the BREAST-Q survey. Decision regret was characterized by the Decision Regret Scale at six months after the operation. Result: Six-four patients were recruited, and fifty-six patients completed the questionnaires (participation rate 87.5%). Forty-three patients had a mastectomy (76.8%) and thirteen patients had BCS (23.2%). Patients who received a mastectomy were found to be less satisfied with the cosmetic outcome of their breasts at six months after the operation (BREAST-Q mean scores pre-op 71.61 vs. post-op 56.63, p= 0.041). Satisfaction of breast cosmesis remained similar in the group of patients who received a BCS (p= 0.746). Neither group demonstrated regret in their decision-making of the operation option (p= 0.487). Conclusions: Elderly patients can show significant dissatisfaction with the cosmetic outcome after a mastectomy. It is crucial to engage the patients in discussion of surgical options to make an informed decision.