Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study

Abstract

BackgroundSubstantial complication rates after postmastectomy breast reconstruction (BR) in breast cancer patients have been reported. Few studies have reported on the resulting psychological distress (PD) and satisfaction with the aesthetic result in relation to postoperative complications after completion of implant or DIEP flap BR. The present study investigated whether women were able to recover from complication related distress in the long term.MethodsPD was prospectively measured using questionnaires regarding anxiety, depression and cancer distress. Eligible patients completed questionnaires before BR (T0, n = 144), after one month (T1, n = 139) and after completion of BR, approximately 21 months after initial reconstructive surgery (T2, n = 119). Satisfaction with the aesthetic result was assessed 21 months after BR. Data concerning complications, subsequent additional surgery and total reconstruction failure up to T2 were collected from the medical records. Analyses were performed using multi-level regression analyses correcting for age.ResultsOne or more complications occurred in 61 patients (42%) and 50 women required subsequent surgery (35%). In time, mean PD significantly declined towards baseline scores independent of complications. However, a total reconstruction failure (n = 10) was significantly associated with a large temporary increase in depression scores. After additional surgery due to complications patients were less satisfied with aesthetic outcome, although patient satisfaction was independent of PD.ConclusionsPD outcomes generally declined to normal levels after completion of the entire BR course. Patients experiencing a total reconstruction failure reported more depression after this loss, but in the long term recovered to the same level as women without complications. These findings indicate that women generally can cope efficiently with these serious adverse events, even if they were less satisfied with the aesthetic result.

Trends in Emotional Functioning and Psychosocial Wellbeing in Breast Cancer Survivors

“…Furthermore, it was found that the reconstruction group had both the highest increase in emotional functioning and an insigni cant decline in psychosocial wellbeing between baseline and a year after surgery. This is in contrast to the ndings from other studies, which found that women who receive breast reconstruction have more mood disturbances and distress than those who undergo mastectomy, up to twelve months after baseline [6,12,[30][31][32]. Perhaps, the difference between previous research and the current study's ndings can be accounted for by differences in practices regarding patient-centered care.…”

“…If that is the case, and patients would have preferred this treatment option, patients should be given space and enough time to express disappointments, ask questions about other possibilities and process any loss of control. Breast reconstruction, on the other hand, is often a product of choice [12,[30][31][32][33][34]. However, the experience of women undergoing reconstruction may vastly differ based on the timing of reconstruction after mastectomy, type of reconstruction, and the occurrence of surgery-related complications [6,12,30,31,34].…”

Experiences of implant loss after immediate implant-based breast reconstruction: qualitative study

“…Although the technical success rates of further reconstructive surgery are high, few studies have included patient‐reported outcomes (PROs) in their assessment of success. The value of existing PRO questionnaires in this group, however, is questionable, as previous questionnaire‐based breast reconstruction studies have suggested that complications, including implant loss, do not adversely affect women's long‐term quality of life, in stark contrast to the present findings. This may be because patients with complications such as reconstructive failure do not self‐identify as having had a reconstruction, so elect not to participate; a number of additional reasons for response bias in breast reconstruction studies have been reported recently.…”

Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients

“…Women experience breast reconstruction (flap) failure as an emotionally very difficult life event, 36 although previous studies have shown that physical and mental health after a breast reconstruction complication generally recover to normal levels after a period. 37,38 By measuring health-related quality of life using multiple, validated patient-reported outcome measures in a large sample of patients following different types of breast cancer surgery, we were able to improve earlier, smaller, and less consistent attempts to assess health-related quality of life in surgically treated breast cancer patients. Our statistically significant results confirm the findings of studies mentioned previously, 15,20,22,32,35 thereby supporting the added value of breast conservation and reconstruction for breast cancer patients.…”