Patient-reported longitudinal symptom patterns following breast-conserving surgery versus mastectomy with or without immediate breast reconstruction: a retrospective cohort study

Introduction — Patients with early-stage breast cancer often choose between breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR). These approaches differ in operative extent, adjuvant treatment pathways, and patient-reported symptom burden. This study compared postoperative longitudinal symptom patterns across these approaches in a population-based cohort.

Methods — This retrospective cohort study included women aged ≥18 with stage I-II breast cancer diagnosed in Ontario between 2010 and 2018 who subsequently underwent BCS, MA, or IBR. Patient-reported symptoms were collected using the Edmonton Symptom Assessment System (ESAS), which evaluates emotional (anxiety, depression), physical (pain, tiredness), and well-being symptoms on a 0-10 scale, with scores ≥4 indicating moderate-to-severe symptoms. Multivariable logistic regression and generalized estimating equations were conducted to compare longitudinal symptom patterns across surgical approaches and identify predictors of symptoms.

Results — The cohort included 19,604 patients (13,337 BCS, 4858 MA, 1409 IBR). Across available ESAS assessments during the first postoperative year, the BCS group showed the lowest overall burden for physical and well-being symptoms. In the primary GEE model, MA was associated with higher odds of moderate-to-severe pain, tiredness, and impaired well-being compared with BCS, while IBR was associated with higher odds of pain and tiredness.

Conclusion — BCS was associated with a more favorable general ESAS symptom profile than MA or IBR. These findings should be interpreted with attention to baseline differences across surgical groups, treatment pathways, and the general rather than breast-specific nature of ESAS.