Researchers surveyed over 700 women who had lumpectomy at the University of Michigan Comprehensive Cancer Center between 2002 and 2006. Nearly one-third reported pronounced breast asymmetry (breasts that looked different from each other), and those women were far more likely to experience symptoms of depression and fear of cancer recurrence compared to women with minimal asymmetry. They were also more likely perceive themselves as being less healthy and rated their quality-of-life lower overall.

Although some women consider breast-conserving lumpectomy less disfiguring than mastectomy, many don't realize that cosmetic outcomes can vary widely. Many women who undergo lumpectomy can end up undergoing multiple surgeries to remove tumor tissue, as well as radiation therapy – both of which can further compromise the look of the breast. And since they're keeping much of their breast tissue, many women who choose lumpectomy may think they're not good candidates for reconstruction.

"It's important for women to think about all 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," said lead researcher Jennifer F. Waljee, MD, MPH.

Need for Candid Conversations

There is currently no standard for pre-operative counseling and what's in practice can vary widely, according to Waljee. She says doctors should be more mindful of addressing expectations at diagnosis and that patients need to seek out as much information as possible.

"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," she said.

Patients should also do as much research as possible to get a realistic idea of the range of outcomes and their reconstructive options. Contacting breast cancer survivorship and advocacy organizations is a good way to get information, Waljee says. (Try the American Cancer Society's Cancer Survivors Network, for example.)

More Research Necessary

Do women who have had mastectomies report similar problems? Can their experiences help women who are having breast-conserving surgery?

University of Michigan researchers are currently collecting data from women who have had mastectomies and those who have had mastectomies with reconstruction, and plan to compare quality-of-life data among the groups and the current study group.

Researchers are also looking into issues that may be affecting women's treatment decisions, such as the referral patterns of their physicians.

Some research has suggested that physicians could be doing a better job of referring breast cancer patients facing mastectomy or lumpectomy to plastic surgeons to discuss reconstruction at the time of their diagnosis. In some cases, a clinic may not be taking a multidisciplinary approach to care, or there may simply be a delay in connecting a patient with a plastic surgeon's office because of scheduling demands. More data is needed in this area.

For more information about breast cancer and its treatment options, see Detailed Guide: Breast Cancer.

Citation: "Effect of Esthetic Outcome After Breast-Conserving Surgery on Psychosocial Functioning and Quality of Life." Published July 10, 2008 in the Journal of Clinical Oncology. First author: Jennifer F. Waljee, MD, MPH. University of Michigan Medical Center.