Abstract
Background
In this study, we report on the changes in psychosocial functioning over 1 year following breast cancer surgery in 3 groups of women, including those with mastectomy alone, those with mastectomy and immediate reconstruction, and those with delayed reconstruction.
Methods
Women with breast cancer at 2 teaching hospitals in Ontario who were undergoing mastectomy alone, mastectomy with immediate reconstruction, or delayed reconstruction were asked to complete a battery of psychosocial questionnaires at their preoperative appointment and 1 year following surgery.
Results
A total of 190 women consented to participate in the study and completed the presurgical questionnaires. There were no presurgical differences between the 3 groups in quality of life, anxiety, depression, or sexual functioning. However, women who were undergoing delayed breast reconstruction (i.e., already had a mastectomy) had higher levels of body stigma (P = 0.01), body concerns (P = 0.002), and transparency (P = 0.002) than women who were undergoing mastectomy alone or mastectomy with immediate reconstruction. Of these women, 158 (83.2%) completed the 1-year follow-up. There were no significant differences in any of the psychosocial functioning scores between the 3 groups.
Discussion
Contrary to the assumed psychological benefits of breast reconstruction, psychological distress was evident among women regardless of reconstruction or timing of reconstruction. Further, psychosocial functioning (including quality of life, sexual functioning, cancer-related distress, body image, depression, and anxiety) was not different at 1-year postsurgery between women with mastectomy alone, mastectomy with immediate reconstruction, and delayed reconstruction. These results suggest that women need psychosocial support after breast cancer diagnosis, even if they have breast reconstruction.
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References
Chart PL, Franssen E. Management of women at increased risk for breast cancer: preliminary results from a new program. Can Med Assoc J. 1997;157:1235–42.
Morris AD, Morris RD, Wilson JF, White J, Steinberg S, Okunieff P, et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival. Cancer J. 1997;3:6–12.
Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.
Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–8.
Balch C, Jacobs L. Mastectomies on the rise for breast cancer: “the tide is changing.” Ann Surg Oncol. 2009;16:2669–72.
Parker P, Youssef A, Walker S, Basen-Engquist K, Cohen L, Gritz ER, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol. 2007;14:3078–89.
Malata CM, McIntosh SA, Purushotham AD. Immediate breast reconstruction after mastectomy for cancer. Br J Surg. 2000;87:1455–72.
Guyomard V, Leinster S, Wilkinson M. Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. The Breast. 2007;16:547–67.
Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36:1938–43.
Winder AE, Winder BD. Patient counseling: clarifying a woman’s choice for breast reconstruction. Patient Educ Couns. 1985;7:65–75.
Goldsmith H, Alday E. Role of the surgeon in the rehabilitation of the breast cancer patient. Cancer. 1971;6:1672–5.
Schain WS. Breast reconstruction. Update of psychosocial and pragmatic concerns. Cancer. 1991;68:1170–5.
Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983;1:459–62.
Noone RB, Frazier TG, Hayward CZ, Skiles MS. Patient acceptance of immediate reconstruction following mastectomy. Plast Reconstr Surg. 1982;69:632–8.
Al-Ghazal SK, Blamey RW. Subcutaneous mastectomy with implant reconstruction: cosmetic outcome and patient satisfaction. Eur J Surg Oncol. 2000;26:137–41.
Stevens LA, McGrath MH, Druss RG, Kister SJ, Gump FE, Forde KA. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 1984;73:619–28.
Roth RS, Lowery JC, Davis J, Wilkins EG. Quality of life and affective distress in women seeking immediate versus delayed breast reconstruction after mastectomy for breast cancer. Plast Reconstr Surg. 2005;116:993–1002.
Fernandez-Delgado J, Lopez-Pedraza MJ, Blasco JA, Andradas-Aragones E, Sanchez-Mendez JI, Sordo-Miralles G, et al. Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Ann Oncol. 2008;19:1430–4.
Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26:17–9.
Ferrans C, Powers M. Quality of life index: development and psychometric properties. ANS Adv Nurs Sci. 1985;8:15–24.
Baxter N. Body Image After Breast Cancer Questionnaire (BIBC). Toronto: University of Toronto; 1997.
Horowitz M, Wilner, N., Alvarez, W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.
Derogatis LR, Spencer PM. BSI administration and procedures manual. Baltimore, MD: Clinical Psychometric Research; 1982.
Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13:595–605.
Thirlaway KJ, Fallowfield L, Cuzick J. The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res. 1996;5:81–90.
Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study. Plast Reconstr Surg. 2003;111:1060–8.
Wilkins EG, Cederna PS, Lowery JC, Davis JA, Kim HM, Roth RS, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106:1014–25; discussion 1026–7.
Nissen MJ, Swenson KK, Ritz LJ, Farrell JB, Sladek ML, Lally RM. Quality of life after breast carcinoma surgery: a comparison of three surgical procedures. Cancer. 2001;91:1238–46.
Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res. 1998;152:396–411.
Schag CA, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L. Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol. 1993;11:783–93.
Maunsell E, Brisson J, Deschenes L. Psychological distress after initial treatment of breast cancer. Assessment of potential risk factors. Cancer. 1992;70:120–5.
Maunsell E, Brisson J, Deschenes L. Social support and survival among women with breast cancer. Cancer. 1995;76:631–7.
Ganz PA, Hirji K, Sim MS, Schag CA, Fred C, Polinsky ML. Predicting psychosocial risk in patients with breast cancer. Med Care. 1993;31:419–31.
Ganz PA, Lee JJ, Sim MS, Polinsky ML, Schag CA. Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. J Clin Epidemiol. 1992;45:473–85.
Maunsell E, Brisson J, Deschenes L. Psychological distress after initial treatment for breast cancer: a comparison of partial and total mastectomy. J Clin Epidemiol. 1989;42:765–71.
Acknowledgment
We wish to acknowledge the Canadian Breast Cancer Foundation (Ontario Chapter) for funding this study. Dr. Metcalfe is supported by the Canadian Institutes of Health Research and the Ontario Women’s Health Council.
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Metcalfe, K.A., Semple, J., Quan, ML. et al. Changes in Psychosocial Functioning 1 Year After Mastectomy Alone, Delayed Breast Reconstruction, or Immediate Breast Reconstruction. Ann Surg Oncol 19, 233–241 (2012). https://doi.org/10.1245/s10434-011-1828-7
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DOI: https://doi.org/10.1245/s10434-011-1828-7