Immediate Breast Reconstruction Helps Patients with Psychological Impact of Mastectomy


Dr. Toni Zhong, Head of Breast Reconstruction Services, UHN

A new Canadian study suggests that immediate breast reconstruction can help patients avoid some of the psychological effects of undergoing mastectomy for breast cancer, compared to waiting for delayed breast reconstruction.

The study is being published in the October issue of Plastic and Reconstructive Surgery and is authored by Dr. Toni Zhong of University Health Network and colleagues from the University of Toronto.

Dr. Zhong and her colleagues report that although immediate reconstruction isn't always an option, "mastectomy with immediate breast reconstruction may protect breast cancer patients from a period of psychosocial distress, poor body image, and diminished sexual well-being, compared to those waiting for delayed breast reconstruction."

The study included 106 patients with breast cancer undergoing mastectomy followed by autologous (using the patient's own tissues) breast reconstruction at University Health Network. Thirty patients underwent immediate reconstruction, performed at the same surgery as mastectomy. The other 76 patients underwent delayed reconstruction, performed an average of three years after mastectomy.

Before and at six, 12, and 18 months after mastectomy, the two groups completed questionnaires assessing a range of psychological factors. Scores were compared to assess differences in the psychosocial impact of and recovery from mastectomy with immediate versus delayed reconstruction.  In both groups, anxiety decreased after breast reconstruction.

After mastectomy, women in the delayed reconstruction group scored lower on measures of body image, sexuality, and health-related quality of life. That suggests that they experienced significant psychosocial distress during the waiting period between mastectomy and breast reconstruction.

Six months after reconstruction, there was no longer any difference in body image between the two groups. At 12 and 18 months, the differences in sexuality scores had disappeared as well. "Body image and appearance concerns may be restored in a relatively short timeframe once the breast mound has been created," Dr. Zhong and her coauthors write. "However, intimacy and sexuality disruptions may require a longer period."

There were some important differences between groups, including a higher rate of invasive breast cancer among women undergoing delayed reconstruction. This reflects the fact that immediate reconstruction is typically offered to women with earlier-stage cancers that don't need additional treatments (such as chemotherapy and radiation therapy).

Lessening the psychosocial impact of breast cancer and its treatment is an important goal of breast reconstruction. The results suggest that, when appropriate, immediate reconstruction can avoid a period of psychosocial distress associated with mastectomy. "In patients who are suitable oncological candidates for immediate reconstruction and are strongly motivated, every effort should be made to coordinate immediate reconstruction with mastectomy," Dr. Zhong and her colleagues conclude. They add that, when the decision is made to delay breast reconstruction until other breast cancer treatments are completed, "the wait-time should be expedited to minimize the duration of psychosocial distress."

Source: Wolters Kluwer Health