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Immediate Breast Reconstruction Reduces Psychological Impact of Mastectomy

Immediate breast reconstruction (IBR) can avoid some of the psychological effects of undergoing mastectomy for breast cancer, compared to waiting for delayed breast reconstruction (DBR), reports a study in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Although immediate reconstruction isn't always an option, "Mastectomy with IBR may protect breast cancer patients from a period of psychosocial distress, poor body image, and diminished sexual well-being, compared to those waiting for DBR," write Toni Zhong, MD, MHS, and colleagues of University of Toronto.

Some Psychological Outcomes Better with Immediate versus Delayed Breast Reconstruction

The study included 106 patients with breast cancer undergoing mastectomy followed by autologous (using the patient's own tissues) breast reconstruction. Thirty patients underwent IBR, performed at the same surgery as mastectomy. The other 76 patients underwent DBR, 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 IBR versus DBR.

Before mastectomy, 26 percent of patients had abnormal anxiety scores and nine percent had abnormal depression scores, with no difference between the IBR and DBR groups. In both groups, anxiety decreased after breast reconstruction.

After mastectomy, women in the DBR 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 IBR and DBR 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 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 DBR. This reflects the fact that IBR 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. While the study is not the first to show psychological benefits of IBR, it provides new information on the course of recovery, compared to DBR.

The researchers note that their study was performed at a specialized breast cancer center in Canada. Compared to the United States, most Canadian centers still tend to perform DBR more frequently than IBR.

The results suggest that, when appropriate, IBR can avoid a period of psychosocial distress associated with mastectomy. "In patients who are suitable oncological candidates for IBR and are strongly motivated, every effort should be made to coordinate IBR with mastectomy," Dr. Zhong and 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."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "A Comparison of Psychological Response, Body Image, Sexuality, and Quality of Life between Immediate and Delayed Autologous Tissue Breast Reconstruction: A Prospective Long-Term Outcome Study"

Article: "A Comparison of Psychological Response, Body Image, Sexuality, and Quality of Life between Immediate and Delayed Autologous Tissue Breast Reconstruction: A Prospective Long-Term Outcome Study" (doi: 10.1097/PRS.0000000000002536)

About Plastic and Reconstructive Surgery

For more than 70 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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