Quality of Life in Patients with Breast Cancer–Related Lymphedema and Reconstructive Breast Surgery

Background  To evaluate the quality of life (QOL) of breast cancer survivors who have undergone breast reconstruction and have breast cancer–related lymphedema (BCRL). Methods  Patients with a unilateral mastectomy with or without breast reconstruction were evaluated for BCRL and their QOL. Patients were divided into a non-BCRL and a BCRL group. Patients with subjective complaints of arm swelling and/or an interlimb volume difference of >200 mL, or undergoing treatment for arm lymphedema were defined as having BCRL. QOL was assessed using cancer-specific (EORTC QLQ-C30 and EORTC QLQ-B23) and disease specific (Lymph-ICF) questionnaires. Results  In total, 253 patients with a mean follow-up time of 51.7 (standard deviation = 18.5) months since mastectomy completed the QOL questionnaires. Of these patients, 116 (46%) underwent mastectomy alone and 137 (54%) had additional breast reconstruction. A comparison of the QOL scores of 180 patients in the non-BCRL group showed a significantly better physical function ( p  = 0.004) for patients with reconstructive surgery compared with mastectomy patients. In the 73 patients with BCRL, a comparison of the QOL scores showed no significant differences between patients with mastectomy and reconstructive surgery. After adjusting for potential confounders, multivariate analysis showed a significant impact of BCRL on physical function ( β  =  − 7.46; p  = 0.009), role function ( β  =  − 15.75; p  = 0.003), cognitive function ( β  =  − 11.56; p  = 0.005), body vision ( β  =  − 11.62; p  = 0.007), arm symptoms ( β  = 20.78; p  = 0.000), and all domains of the Lymph-ICF questionnaire. Conclusions  This study implies that BCRL has a negative effect on the QOL of breast cancer survivors, potentially negating the positive effects on QOL reconstructive breast surgery has.