Breast-Conserving Therapy Preserves Sexual Well-Being More than Postmastectomy Breast Reconstruction: Trends, Factors, and Interventions.

Abstract

Up to 85% of patients with breast cancer report sexual health concerns, but their concerns are not adequately addressed by providers. Sexual dysfunction among patients with breast cancer remains understudied. The authors aimed to investigate the impact of breast-conserving therapy (BCT) and postmastectomy breast reconstruction (PMBR) on the sexual health of patients with breast cancer and the frequency of sexual medicine consultation in postoperative care. The authors conducted a retrospective analysis of patients who underwent BCT or PMBR and completed the Sexual Well-Being section of the BREAST-Q BCT and Reconstruction modules from January of 2010 through October of 2022. They compared Sexual Well-Being scores between patients who received BCT or PMBR over time up to 5 years after surgery, delineated associated demographic and clinical factors with Sexual Well-Being scores, and evaluated the frequency of sexual medicine consultations. Of 15,857 patients, 8510 (53.7%) underwent BCT and 7347 (46.3%) underwent PMBR. Patients who underwent PMBR had significantly lower Sexual Well-Being scores than patients who underwent BCT from preoperatively to 5 years postoperatively. Regression analyses showed that patients who underwent PMBR scored 7.6 points lower at 1 year than patients who underwent BCT. Separated marital status, higher body mass index, cardiovascular disease, hyperlipidemia, psychiatric diagnosis, and neoadjuvant chemotherapy were associated with significantly lower Sexual Well-Being scores. A total of 299 patients (3.5%) who underwent BCT and 400 patients (5.4%) who underwent PMBR received sexual medicine consultations. Sexual health concerns must be considered in breast cancer care, particularly among patients who undergo PMBR. Although many patients experience sexual dysfunction, most do not receive a sexual medicine consultation, suggesting an opportunity for providers to improve the sexual health of patients with breast cancer. Therapeutic, III.