A comparative study of quality of life and psychosocial adaptability following modified radical mastectomy and breast reconstruction

Breast cancer is one of the most prevalent malignancies worldwide. Modified radical mastectomy, as a conventional treatment for breast cancer, often leads to body image disturbance, which in turn can trigger negative psychosocial changes (such as anxiety, low self-esteem, and social withdrawal) and significantly impairs patients' long-term quality of life. This study compared the differences in quality of life (QoL) and psychosocial adaptability between patients who underwent modified radical mastectomy and those who received breast reconstruction, with the aim of elucidating the long-term effects of these two surgical procedures on patients' post-operative physical and mental well-being. Retrospective data were collected from breast cancer patients who underwent modified radical mastectomy or breast reconstruction at our institution between 2014 and 2020, and patients were assigned to the corresponding surgical groups. Propensity score matching was used to balance baseline characteristics (e.g., age, tumor stage, and education level) between the two groups. All included patients completed an online survey, which included the Functional Assessment of Cancer Therapy-Breast (FACT-B, a validated QoL scale with a total score range of 0-144, where higher scores indicate better QoL) and the Psychosocial Adaptation Questionnaire (PAQ, a scale evaluating psychosocial adaptability with a total score range of 0-100, where higher scores indicate stronger adaptability). Statistical analyses were performed using the Wilcoxon rank-sum test (for non-normally distributed data) and two-sample independent t-test (for normally distributed data). A total of 260 matched patients (130 in each group) were included in the final analysis. Compared with the modified radical mastectomy group, the breast reconstruction group showed significantly better outcomes: (1) FACT-B score: the reconstruction group had a mean score of (107.58 ± 16.2), while the mastectomy group had a mean score of (100.18 ± 8.5),P < .01.(2) The total PAQ scores of the two groups were 176 (163,186) and 164 (158,172), respectively, with statistically significant differences (P < .01). Subgroup analysis further confirmed that the advantages of breast reconstruction in QoL and psychosocial adaptability were consistent across patients with different post-operative follow-up periods (< 3 years, 3-5 years, > 5 years). Breast reconstruction was associated with enhanced self-acceptance and self-identity, reduced psychological burden, and improved physical condition, and help them achieve a better quality of life and psychosocial adaptability. These findings provide evidence for optimizing breast cancer treatment decision-making in clinical practice. Healthcare providers (including nurses, surgeons, and psychologists) should fully inform patients of the psychosocial and functional benefits of breast reconstruction, and develop personalized care plans to support patients in selecting surgical options that match their physical conditions and psychological needs, ultimately improving their long-term post-operative recovery outcomes.