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The Impact of Radiotherapy on Long-Term Satisfaction and Health Related Quality of Life in Post-mastectomy Breast Reconstruction - An Analysis of 3,265 Patients
Jonas Nelson, MD1, Thais Polanco, MD1, Meghana Shamsunder, MPH1, Nikhil Sobti1, Collen McCarthy, MD1, Evan Matros, MD, MMSc, MPH1, Joseph Dayan, MD1, Joseph Disa, MD2, Peter Cordeiro, MD1, Andrea Pusic, MD1, Babak Mehrara, MD1, Robert Allen, Jr., MD1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Memorial Sloan Kettering Cancer Center, ny, NY, USA.

Abstract
Background: This study aims to assess the effects of radiation therapy (XRT) on long-term satisfaction and health related-quality of life in patients undergoing post-mastectomy, implant-based (IBR) or autologous breast reconstruction (ABR).
Methods: BREAST-Q scores for women who underwent IBR or ABR at a tertiary academic cancer center were prospectively collected from 2010 - 2017 as part of routine care. Mean scores for satisfaction with breasts, outcome, and physical well-being of the chest were examined by XRT status, timing, and reconstructive modality preoperatively and at years 1-5 using non-parametric analyses and regression analyses.
Results: Of 3,265 included patients, 867 patients underwent XRT. XRT patients at preoperative timepoints or postoperatively scored significantly lower than non-XRT patients (p < 0.01; Figure 1). Patients with XRT had lower physical well-being scores compared to patients without XRT at each postoperative time-point (years 1-5). ABR patients with XRT had higher breast satisfaction scores than IBR with XRT (p < 0.01).
Conclusion: Largest prospective examination on effects of XRT on PRO in breast reconstruction patients utilizing the BREAST-Q to date. XRT adversely impacts long-term postoperative breast satisfaction and physical well-being of the chest. Timing of XRT to TE or implant did not significantly effect breast satisfaction and physical wellbeing in IBR patients. This data can improve preoperative counseling for modality decision making, informed consent, and expectation management in patients undergoing breast reconstruction in the setting of XRT.


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