Quality of life after breast (reconstructive) surgery—an interim analysis of a prospective three-arm clinical trial with a 10-year follow-up (REKO 001)

BACKGROUND: Long-term health-related quality of life (HRQoL) plays an increasingly important role in breast cancer treatment. Women who are not eligible for breast-conserving therapy frequently opt for reconstruction, but data on long-term health-related quality of life comparing different reconstructive surgeries is rare. METHODS: REKO 001-trial is a single-center, three-arm study with a prospective longitudinal design and 10-year follow-up, investigating which surgery is associated with the highest quality of life. Between January 2017 and March 2022, 227 patients underwent either mastectomy (74), implant-based (77), or Deep Inferior Epigastric Perforator (DIEP) or Fascio-Cutaneous Infragluteal (FCI) free flap (76) reconstruction. This initial follow-up analysis compared HRQoL (BREAST-Q, FACT-B) and postoperative complications 5 months after surgery. RESULTS: The DIEP/FCI group had the lowest preoperative BREAST-Q scores, but was the only group to show significant increases in many HRQoL domains within the first 5 months postoperatively. The mastectomy group showed significant decreases in some HRQoL domains. The implant-based group started with the highest BREAST-Q scores in most domains and had higher HRQoL scores than the mastectomy group. Radiotherapy and higher BMI significantly reduced HRQoL in some domains. The number of complications requiring inpatient treatment or reoperation within the first 5 months increased with extent of surgery (p = 0.037). CONCLUSION: For patients opting for DIEP/FCI reconstruction, an increase in HRQoL can be seen within the first 5 months after surgery, but they must accept the higher risk of complications and a decrease in abdominal well-being. Further follow-ups after 2, 5, 7, and 10 years are underway.