Preoperative and Postoperative Change in Patient-Reported Health-Related Quality of Life Outcomes in Breast Cancer Surgery Patients Across Surgical Modalities: A Prospective Study

<b>Background</b>: This study compared the change in pre- and postoperative health-related quality of life (HRQoL) among breast cancer patients undergoing breast-conserving surgery (BCS), total mastectomy no reconstruction (TMNR), and total mastectomy immediate breast reconstruction (MIBR). Patient factors associated with postoperative anxiety and depression were also identified. <b>Methods</b>: This prospective cohort study enrolled breast cancer patients between September 2017 and August 2020. HRQoL changes from preoperative to six months postoperative were compared using patient-reported outcome tools assessing anxiety, depression, pain, perceived health, breast satisfaction, psychosocial, physical, and sexual well-being and analyzed with ANOVA and linear regression. <b>Results</b>: A total of 471 patients completed preoperative and postoperative surveys (BCS: 313, TMNR: 60, MIBR: 98). Postoperative anxiety decreased across all modalities, with MIBR showing the greatest reduction (<i>p</i> = 0.03), though still exhibiting the highest postoperative anxiety (<i>p</i> = 0.05). Depression and perceived health scores showed no significant difference in change across modalities (<i>p</i> = 0.15, <i>p</i> = 0.48). MIBR patients showed the greatest increase in pain (<i>p</i> = 0.05) and the highest postoperative pain scores (<i>p</i> = 0.04). All three modalities showed a clinically significant decline in physical and sexual well-being. TMNR and MIBR had additional reductions in breast satisfaction, with TMNR also showing a decline in psychosocial well-being. Absolute postoperative scores for breast satisfaction, psychosocial, physical, and sexual well-being remained highest in BCS compared to TMNR and MIBR (<i>p</i> < 0.01, for each domain). In multivariable regression analysis, postoperative depression and anxiety scores did not differ between surgical modalities, but younger age was significantly associated with higher postoperative depression, pain and anxiety (<i>p</i> < 0.01), and adjuvant chemotherapy with higher postoperative depression (<i>p</i> < 0.01). <b>Conclusions</b>: BCS may have better overall HRQoL outcomes, specifically in breast satisfaction, psychosocial, physical, and sexual well-being, compared to TMNR and MIBR. Additionally, younger age, rather than surgical modality, was found to be associated with higher postoperative depression, pain, and anxiety scores.