An Evaluation of the Impact of Mental Illness on Postoperative Breast Reconstruction Revision Surgery

Abstract

Background: Breast cancer impacts millions of people yearly affecting various aspects of their lives—including but not limited to mental health. Patients with a known psychiatric history, specifically generalized anxiety disorder (GAD) and/or depression, have previously been shown to have an increased number of revisions after breast reconstruction. Methods: A commercially available database of 91 million unique patients, PearlDiver, was used to identify patients with breast cancer who underwent autologous free flap breast reconstruction. An average number of revisions were calculated from each group of patients—those with a history of anxiety and/or depression and patients without a history of anxiety and/or depression. A logistic regression was performed to determine risk factors associated with patients undergoing revision surgery. Results: A total of 39,683 patients with a history of breast cancer underwent autologous breast reconstruction between 2010 and 2020, of which 6308 (15.9%) patients had a history of GAD and/or depression before autologous reconstruction. A total of 13,422 (33.8%) patients received at least one revision surgery. Patients with GAD only, depression only, and concomitant GAD and depression received 1.40 revisions each with no significant differences between the control and any of the study groups (P = 0.956). Logistic regression did not find psychiatric history to be associated with patients undergoing revision surgery (OR, 0.94; 95% CI, 0.89–1.00). Conclusion: Patients who underwent autologous reconstruction for breast cancer demonstrated no difference in rates of secondary surgical revision, regardless of a concurrent mental health history.

Effects of Elective Revision after Breast Reconstruction on Patient-Reported Outcomes

“…11,17 Some studies suggest that patients with psychiatric disorders such as anxiety may be more likely to undergo revision procedures, although the evidence is inconclusive. [18][19][20] While previous studies have explored factors associated with increased revision rates, few studies have investigated the impact of revision procedures on patient satisfaction. Given that these elective revision procedures carry risk, require recovery time, and have financial implications, it is important to investigate whether they in fact improve patient satisfaction.…”

“…11 18 Some studies suggest that patients with psychiatric disorders such as anxiety may be more likely to undergo revision procedures, although the evidence is inconclusive. 19 20 21…”

Transtornos Mentais Em Pacientes Submetidos a Cirurgias Plásticas: Uma Revisão Sistemática

“…Sob outro viés, Saifee J et. al (2023) 10 e White A, et al (2023) 11 também elucidam sobre a influência positiva de cirurgias plásticas em alguns casos 10,11 . A reconstrução mamária, por exemplo, foi acompanhada de redução da ansiedade e depressão nos pacientes 10. De forma similar, a mamoplastia redutora para pacientes com macromastia bilateral sintomática¹¹, que pode melhorar a qualidade de vida e a saúde mental, tendo em vista que o diagnóstico, a princípio, é capaz de atingir, intensamente, fatores sociais relevantes para a sociedade em geral, ocasionam baixa autoestima e ansiedade social, além da própria vergonha causada pelo diagnóstico 10,11 .…”