Beyond Surgery: Psychological Well-Being's Role in Breast Reconstruction Outcomes

Authors

Jose Foppiani, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Theodore C. Lee, Georgetown University, Washington, District of Columbia.
Angelica Hernandez Alvarez, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Maria J. Escobar-Domingo, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Iulianna C. Taritsa, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Daniela Lee, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Kirsten Schuster, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Sasha Wood, Yale University, New Haven, Connecticut.
Begum Utz, Izmir Biomedicine and Genome Center, Izmir, Turkey.
Christopher Bai, Lawrenceville School, Lawrenceville, New Jersey.
Lauren Maranhao-Wong, Los Altos High School, Los Altos, California.
Bernard T. Lee, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: blee3@bidmc.harvard.edu.

Document Type

Article

Publication Title

The Journal of surgical research

Abstract

INTRODUCTION: Breast cancer is one of the most prevalent cancers worldwide, and following its treatment, many women turn to plastic surgery for reconstruction. A diagnosis of cancer is a heavy burden on patients. Yet, the effect of psychological/psychiatric comorbidities on patient satisfaction following their reconstruction remains unexplored. Thus, this paper aims to investigate how pre-existing psychological and psychiatric conditions impact patient-reported outcomes postreconstruction, compared to women without such conditions. METHODS: A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed, and a subgroup analysis was then performed using a random effect model. RESULTS: A total of 24 papers were included, encompassing a total population of 220,565 patients undergoing breast reconstruction between the ages of 18 and 84. The follow-up time ranged between 1.5 mo and 61 mo. In our study of breast reconstruction outcomes, the cohort with psychological/psychiatric comorbidities exhibited significant decreases in postoperative BREAST-Q scores compared to the control group: a 24-point [95% confidence interval (CI; -40, -8)] difference in satisfaction, a 20-point [95% CI (-57, -17)] difference in psychosocial well-being, an 18-point [95% CI (-28, 9)] difference in physical well-being, and a 33-point [95% CI (-51, -15)] difference in sexual well-being. CONCLUSIONS: Ultimately, our analysis suggests that presurgical psychology status is a critical determinant of postsurgical patient-reported outcomes. These results encourage the development and inclusion of well-being screening and optimization prior to surgery as a mean to improve surgical outcomes.

First Page

26

Last Page

35

DOI

10.1016/j.jss.2024.10.040

Publication Date

1-1-2025

Recommended Citation

Foppiani, Jose; Lee, Theodore C.; Alvarez, Angelica Hernandez; Escobar-Domingo, Maria J.; Taritsa, Iulianna C.; Lee, Daniela; Schuster, Kirsten; Wood, Sasha; Utz, Begum; Bai, Christopher; Maranhao-Wong, Lauren; and Lee, Bernard T., "Beyond Surgery: Psychological Well-Being's Role in Breast Reconstruction Outcomes" (2025). Surgery. 261.
https://scholar.bridgeporthospital.org/surgery/261

Identifier

39637444 (pubmed); 10.1016/j.jss.2024.10.040 (doi); S0022-4804(24)00706-6 (pii)