Importance Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown.

Objective To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors.

Design, Setting, and Participants This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women’s Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study.

Exposures Primary breast surgery, reconstruction, and radiotherapy.

Main Outcomes and Measures Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain.

Results A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = −7.4; 95% CI, −12.8 to −2.1; P = .007) and complex reconstruction (vs autologous) with worse physical well-being (β = −14.0; 95% CI, −22.2 to −5.7; P < .001).

Conclusions and Relevance These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.

重要性 双侧乳房切除术的增加在年轻的乳腺癌女性中最为明显，但手术与长期生活质量 (QOL) 之间的关系仍然很大程度上未知。

目的 探讨年轻乳腺癌幸存者手术与长期满意度和生活质量的关系。

设计、设置和参与者 这项前瞻性队列的多中心横断面研究于 2016 年 10 月至 2017 年 11 月在北美的学术和社区医院进行。对参加年轻女性乳腺癌研究的 40 岁或以下女性进行了评估。在研究结束后的 1 至 2 年内进行数据分析。

曝光 初级乳房手术、重建和放射治疗。

主要结果和措施 ：按手术类型比较平均 BREAST-Q 乳房满意度和身体、心理社会和性健康评分；较高的 BREAST-Q 分数（范围，0-100）表示较好的 QOL。线性回归用于识别与每个领域的 BREAST-Q 评分相关的人口统计学和临床​​因素。

结果 共有 560 名 0 至 III 期乳腺癌女性（诊断时的中位年龄为 36 岁；范围为 17-40 岁；484 名 [86%] 患有 0-II 期疾病）完成了 BREAST-Q，中位值为 5.8年（范围，1.9-10.4 年）从诊断。共有290例（52%）患者接受了双侧乳房切除术，110例（20%）患者接受了单侧乳房切除术，160例（28%）患者接受了保乳治疗。在乳房切除术患者中，357 人（89%）进行了重建，181 人（45%）接受了放射治疗。在多变量分析中，基于植入物的重建（相对于自体）与乳房满意度降低（β = -7.4；95% CI，-12.8 至 -2.1；P  = .007）和复杂的重建（相对于自体）与身体状况较差相关-存在（β = -14.0；95% CI，-22.2 至 -5.7；P < .001)。

结论和相关性 这些结果表明，无论乳房重建如何，年轻乳腺癌幸存者的局部治疗与多个 QOL 领域的较差评分持续相关，特别是在接受乳房切除术和放疗的患者中。社会经济压力似乎也起作用。