Breast asymmetry after cancer treatment affects quality of life, U-M study finds

Poor aesthetic outcome after lumpectomy linked to depression, fear


ANN ARBOR, Mich. — Most women with breast cancer assume that surgery to preserve their breast will be less disfiguring than a mastectomy that removes the entire breast.
But nearly one-third of women reported pronounced asymmetry between their breasts, and that perceived disfigurement greatly affects a woman’s quality of life after treatment, according to a new study by researchers at the University of Michigan Comprehensive Cancer Center.

The researchers found that compared to women with little to no breast asymmetry, women whose affected breast looked significantly different were twice as likely to fear their cancer recurring and to have symptoms of depression. These women were also more likely to perceive themselves as less healthy and to feel stigmatized by their breast cancer treatment.

“We found that one of the most important factors of post-operative quality of life and satisfaction was post-operative asymmetry or the aesthetic outcome that women experienced after their surgery,” says lead study author Jennifer Waljee, M.D., M.P.H., a resident in general surgery at the U-M Medical School.

Results of the study appear in the July 10 Journal of Clinical Oncology.

Many women who are diagnosed with breast cancer will have a choice between breast conserving surgery, in which just the tumor and a margin of surrounding tissue are removed, and mastectomy, which removes the entire breast. Reconstructive surgery is an option after mastectomy but also can help correct asymmetry from breast conserving surgery.

“It’s important for women to think about all of those issues at the time that they’re making their surgical decision and realize that although breast conserving surgery may or may not be less disfiguring than mastectomy, they’re likely to experience some asymmetry afterwards that may impact their quality of life,” Waljee says.

Typically, surgeons counsel mastectomy patients before surgery on the types of aesthetic changes they can expect. Women who undergo breast conserving surgery may not be receiving the same level of counseling, the researchers suggest, leaving them with inaccurate expectations of what their breast will look like after surgery.

“It’s important for breast surgeons to have an open and honest dialog with their patients so that they understand patients’ expectations before surgery and can better address post-operative recovery needs,” Waljee says.

In the United States, 182,460 women will be diagnosed with breast cancer this year and 40,480 will die from the disease, according to the American Cancer Society.

Methodology: The authors mailed surveys to all women who underwent breast conserving surgery at the University of Michigan Health System between January 2002 and May 2006; 714 women responded.

Additional authors: Emily S. Hu, M.D., U-M plastic surgery; Peter A. Ubel, M.D., U-M internal medicine and VA Ann Arbor Healthcare System; Dylan M. Smith, Ph.D., U-M internal medicine and VA Ann Arbor Healthcare System; Lisa A. Newman, M.D., M.P.H., U-M general surgery; and Amy K. Alderman, M.D., M.P.H., U-M plastic surgery.

Funding source: Robert Wood Johnson Clinical Scholars Program at the University of Michigan

Reference: Journal of Clinical Oncology, Vol. 26, Issue 20, July 10, 2008