Following definitive surgical therapy, we interviewed patients at 4-6 weeks (T1), six months (T2), twelve months (T3), and twenty-four months (T4). Using the Generalized Estimating Equation method and adjusting for demographic, clinical, and psychological characteristics, we looked at the longitudinal connections between body image issues, surgery type, and the severity of postoperative side effects. We examined the surgical type regression coefficients from two models, one with and one without severe surgical side effects. Of the 549 patients participated, 514 (94%) completed all four interviews (mean age 58; 75% White; 65% BCS; 12% mastectomy; 23% mastectomy with reconstruction).

   Patients who underwent mastectomy with reconstruction reported having a worse body image than patients who received BCS at T1-T3 (each P 0.02) but not at T4 in the model without the severity of surgical side effects. In comparison to patients who underwent mastectomy alone, patients who underwent mastectomy with reconstruction also reported having a worse body image at T2 (P = 0.0106). Body image scores did not significantly differ between patients with BCS and mastectomy with reconstruction at any interview after controlling for the severity of the surgical side effects; however, patients who underwent mastectomy alone had better body image at T2 than patients who underwent mastectomy with reconstruction (P = 0.011). The severity of surgical side effects was used to explain how different types of surgery affected body image within the first year of definitive surgical therapy.

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https://pubmed.ncbi.nlm.nih.gov/20686836/