Objective: To compare patient-reported outcomes of breast-conserving surgery (BCS) and breast reconstruction post-mastectomy (BRPM) at Mater Dei Hospital using the BREAST-Q™ questionnaire, with a focus on multiple quality-of-life domains including satisfaction with breasts, psychosocial well-being, physical well-being, sexual well-being, fatigue, cancer worry and impact on work.

Methods: This retrospective audit analysed 46 patients treated between 2017 and 2020 at Mater Dei Hospital, Malta: 23 underwent BCS via wide local excision, and 23 underwent two-stage implant-based reconstruction following mastectomy. To reduce variability, only cases performed by a single breast surgeon were included, and age distributions were matched between groups. Patient-reported outcomes were assessed using the validated BREAST-Q™ version 1.0 questionnaire. Statistical comparisons between the BCS and BRPM groups were conducted using the Mann-Whitney U test.

Results: BCS patients reported higher scores in physical well-being (70.0% versus 64.6%, p = 0.01) and slightly better sexual well-being (73.3% vs versus 66.7%, p = 0.83), while BRPM patients showed higher psychosocial well-being (74.0% vs versus 69.4%, p = 0.17). Satisfaction with breast outcomes appeared higher in the BCS group when expressed as a percentage of the maximum possible score (83.5% vs versus 63.3%, p = 0.43), though raw scores favoured BRPM. Cancer worry, fatigue and impact on work scores were similar between groups, with no statistically significant differences.

Conclusion: Both BCS and BRPM yielded broadly comparable patient-reported outcomes across most domains. BRPM was associated with higher psychosocial well-being, while BCS patients experienced better physical and sexual well-being. The only statistically significant difference was found in physical well-being, favouring BCS. These findings underscore the importance of personalised counselling and shared decision-making to align surgical choices with patient values and expectations.