The impact of scars on health-related quality of life after breast surgery: a qualitative exploration

Abstract

Purpose The purpose of this research was to explore women’s experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). Material and methods A qualitative study using semi-structured face-to-face interviews was conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were “physical and sensory symptoms,” “impact of scar symptoms,” “personal factors,” “impact of scar interventions,” and “change over time.” Results The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. Conclusion Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. Implications for Cancer Survivors Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.

“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”

“…3,11,14,42–44 In this regard, the advantage of closed-incision negative-pressure therapy is twofold: first, as closed-incision negative-pressure therapy keeps the edges together and reduces lateral tension, its use will improve wound healing. 15,17,21,56,59,64 Second, the closed-incision negative-pressure therapy type in this study was cut to size (up to 120 cm). In DIEP flap operations, a single unit of this closed-incision negative-pressure therapy type will suffice to cover the whole abdominal incision.…”

Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps—A Comparative Cohort Study

“…There are several plausible explanations for this unexpected finding. For example, the abdominal area is more visible to the patient (in comparison to the back area) and the effect of scarring itself might be underestimated in breast reconstruction 48,49 . Further, this could also be related to a difference in expectations.…”

Breast and abdominal scarring after DIEP flap breast reconstruction: An exploration of patient-reported scar quality

“…Nevertheless, little is known about how women appraise their breast and abdominal scars after DIEP flap BR. Based on our previous research on scarring after breast surgery [9], scar characteristics such as pain, stiffness, movement restrictions, noticeability, location, and size, determine scar appraisal. Furthermore, it is unknown how factors such as patient characteristics (e.g.…”

“…Subsequently, the patients' overall opinion of the scar is assessed with one stand-alone item, where '10' corresponds to the worst imaginable scar [13]. Furthermore, scar symptoms numbness, stinging/tingling sensations, tightness and movement restrictions, were assessed on a numeric rating scale (NRS) based on our previous research [9]. The items were scored on a 10-point scale, where 1= 'no, not at all' and 10= 'yes, very much'.…”