Effects of Reconstructive Surgery After Breast Cancer

Breast cancer, particularly when a mastectomy is involved, can be devastating to a woman's self-image and self-confidence. One procedure which helps to minimize the psychosocial aspect of such a surgery is breast reconstruction, sometimes performed at the time of the mastectomy. A study to evaluate the psychosocial outcomes and body image of mastectomy reconstruction patients has shown ongoing benefits to women in self-esteem, body image and general well-being two years after undergoing the procedure.

Dr. Dunya Atisha of the University of Michigan Medical Center in Ann Arbor led the research group who wrote, "We prospectively evaluated the psychosocial outcomes of breast cancer patients 2 years post-transverse rectus abdominis musculocutaneous flap or expander/implant breast reconstruction using a multicenter approach. We found that psychosocial benefits and body image gains continued to manifest at 2 years. In addition, procedure type had a surprisingly limited effect on psychosocial outcomes."

Previous studies have suggested substantial psychosocial benefits in breast cancer patients at one year post-reconstruction. However, until now, the possibility of psychosocial outcomes continuing to improve in subsequent years had remained uncertain. The new study showed that two years later, generally, patients were still experiencing increases in energy and the ability to work, and decreases in anxiety, which allowed them to better enjoy social activities.

The analysis included 173 patients from the Michigan Breast Reconstruction Outcome Study, with 23 surgeons in 12 centers studying mastectomy reconstruction patients. The participants submitted both preoperative and two year post-operative surveys. 116 of the patients underwent immediate reconstructive surgery, post mastectomy, while 57 had delayed reconstructive procedures.

Those having immediate surgery showed significant improvements in all applicable psychosocial areas other than body image regardless of the type of procedure they had undergone. The delayed reconstructive procedure patients only showed noteworthy change in body image. Women who underwent a procedure known as TRAM (transverse rectus abdominis musculocutaneous flaps) in which tissue from the lower abdomen is used to reconstruct the breast, had much higher gains in body image than those receiving artificial implants.

It remains unclear as to why there are major differences in overall psychosocial improvements between the immediate surgery patients and the delayed surgery patients. However, a delay in reconstructive surgery is not always a matter of choice, as some women may need to undergo radiation therapy following a mastectomy, thereby preventing immediate reconstructive measures to be taken.

Dr. Atisha and the research team agree that additional long-term studies are needed to determine how different procedures will ultimately affect a patient's psychological welfare.

The study was included in the June publication of the Journal of Annals of Surgery, a highly referenced surgery journal that provides the international medical community with information on significant contributions to the advancement of surgical science and practice. Affiliated societies to the journal include the American Surgical Association, the European Surgical Association, the New York Surgical Society, and the Philadelphia Academy of Surgery.