Breast
CME
.jpg "Minji Kim, BS photo")
Minji Kim, BS
Research fellow, Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering, United States
Disclosure(s): No financial relationships to disclose
Minji Kim, BS
Research fellow, Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering, United States
Disclosure(s): No financial relationships to disclose
Carrie Stern, MD
Attending, Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering, United States
Disclosure information not submitted.
Kevin Zhang, BS
Research fellow, Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering, United States
Disclosure information not submitted.
Perri Vingan, BS
Research fellow, Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering, United States
Disclosure information not submitted.
Elizabeth Smith-Montes, MS
Research fellow, Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering, United States
Disclosure information not submitted.
Lillian Boe, PhD
Statistician, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering, United States
Disclosure information not submitted.
Jeanne Carter, PhD
Psychologist, Department of Psychiatry and Behavioral Sciences
Memorial Sloan Kettering, United States
Disclosure information not submitted.
Babak J. Mehrara, MD
Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
.jpg "Audree Tadros, MD MPH photo")
Audree Tadros, MD MPH
Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, NY, United States
Disclosure information not submitted.
Robert J. Allen, Jr., MD
Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
Jonas A. Nelson, MD, MPH
Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
Sexual well-being is the third most common concern reported by breast cancer patients, though it is often overlooked in postoperative survivorship. This study aims to understand sexual well-being in breast cancer patients, including the trend, associated factors, and interventions.
Methods:
We performed a retrospective analysis of patients who underwent breast reconstruction or lumpectomy and completed the BREAST-Q sexual well-being module between 2010 and 2021. We compared reconstruction and lumpectomy patients over time, delineated associated demographic and clinical factors, and evaluated the incidence and impact of sexual medicine consultations.
Results:
16,061 lumpectomy and breast reconstruction patients were included. Breast reconstruction patients had consistently lower sexual well-being across time than lumpectomy patients, from preoperative to 5-year follow-up (p < 0.001) (Graph I). In reconstruction, factors associated with significantly lower sexual well-being at 1-year included psychiatric disorders (ß=-8.1), higher BMI (ß=-0.48), axillary dissection (ß=-3.4), and advanced cancer stage (ß=-2.45). Single and separated patients had lower sexual well-being than married patients (ß=-5.0, p< 0.001; ß=-4.0, p=0.007, respectively). Other factors associated with higher sexual health at 1-year included premenopausal status (ß=2.7, p=0.034) and nipple-sparing mastectomy (vs. skin-sparing, ß=3.0, p=0.018).
Overall, 5.5% of 6,779 reconstruction patients received a sexual medicine consultation. Patients who were younger (OR=0.95), from a lower income bracket (OR=2.98), and underwent unilateral mastectomy (vs. bilateral, OR=1.63) and lymph node dissection (OR=3.24) were significantly more likely to receive consultation. The consultation cohort had significantly lower preoperative BREAST-Q sexual health score relative to the cohort without consultation: median score=27(interquartile range 0, 43) vs. 41(0,57). At 1-year postoperatively, these differences were still apparent (46(32,59) vs. 51(39,66), p< 0.001). Within the consultation group, the score improved from 10(22,53) to 31(31,53) (p=0.004) following consultation.
Conclusions:
Decreased sexual well-being is imperative to consider in breast reconstruction patients, particularly among those who are separated/single or have psychiatric disorders and advanced cancer. Only a small fraction of patients receives sexual medicine consultation, yet such intervention improves patients’ sexual health. Providers should assess sexual well-being during post-mastectomy breast reconstruction and refer for sexual medicine consultations when appropriate to improve sexual well-being.