Post-mastectomy reconstruction: a comparative analysis on psychosocial and psychopathological outcomes

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Summary

Although multiple benefits have been reported from post-mastectomy reconstruction and particularly from an immediate procedure, limited psychiatric evaluation has been published. The present study was planned to evaluate the psychosocial and psychopathological outcome in patients who had undergone post-mastectomy breast reconstruction. We also investigated if any psychopathological condition could significantly affect the benefits of the reconstructive procedure. We compared 33 breast-reconstructed patients with 33 patients with mastectomy alone and 33 healthy women. All women underwent a psychiatric interview with four questionnaire-based scales (SASS, QL-index, HAM-A, HAM-D) to assess social adaptation, quality of life, anxiety and depression. A 4-point scale evaluated reconstructed patients' satisfaction. After a year, there was no statistical difference in social, sexual relationships and quality of life among reconstructed patients and healthy women. Regarding anxiety, no statistical difference was found between reconstructed and mastectomy groups. Statistically different lower depression levels in the healthy group and higher levels in the mastectomy group were found. Depression in the reconstructed group decreased compared to the mastectomy group. Differences between timing and reconstructive techniques were not statistically validated. Eight patients were dissatisfied (24.2%). Immediate reconstructed patients who had pre-existing major depressive disorder were dissatisfied. Breast-reconstructed patients' quality of life, social and sexual relationships are not significantly different to those of healthy women. Anxiety does not decrease. Timing and techniques do not seem to influence, significantly, outcome and satisfaction. Pre-existing diagnosis of major depressive disorder may be a contraindication to immediate breast reconstruction.

Section snippets

Patients and methods

This study was performed by the Plastic Surgery Department and the Psychiatry Department of the University of Sassari in Sardinia, Italy. Three groups of women were identified. Group I included all consecutive patients who, between April 2001 and April 2002, underwent breast reconstruction with Becker's permanent expander/implants or TRAM flaps (pedicled and free). Group II collected the same number of patients who had undergone mastectomy for breast cancer and who were waiting for

Results

Only one patient (immediate implant) received adjuvant radiotherapy followed by a poor outcome and dissatisfaction. The same patient was identified as the only one who did not conclude the reconstructive programme with the nipple–areola complex reconstruction.

There was no significant difference between immediate and delayed reconstructed patients and between implants and TRAM flaps treated patients in respect of post-operative complications (Table 2).

Discussion

The psychological sequelae following breast cancer diagnosis and subsequent mastectomy are well recognized and represent the most important reason which prompt the patients to a breast reconstructive consultation.1, 2, 3, 4 Nowadays, the evolution of breast reconstruction can offer valid options to help these women to re-establish their ‘normal’ life. In the modern health care system, satisfaction and quality of life measurements become the main instruments and goals to evaluate treatments and

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    Presented in part at the VIIIth Congress of Italian and American Plastic Surgeons, Ischia, Italy, 6–8 June 2002 and at the British Association of Plastic Surgeons Summer Meeting, Newport, South Wales, UK, 2–4 July 2003.

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