Prospective analysis of psychosocial outcomes in breast reconstruction: One-year postoperative results from the Michigan Breast Reconstruction Outcome Study

In the past decade, changing attitudes toward breast reconstruction among b oth patients and providers have led a growing number of women to seek breas t reconstruction after mastectomy. Although investigators have documented t he psychological, social, emotional, and functional benefits of breast reco nstruction, little research has evaluated the effects of procedure choice o n these outcomes. The current study prospectively evaluated and compared ps ychosocial outcomes for three common options for mastectomy reconstruction: tissue expander/implant, pedicle TRAM, and free TRAM techniques. In a prospective cohort design, patients undergoing postmastectomy reconstr uction for the first time with expander/implant, pedicle TRAM, or free TRAM procedures were recruited from 12 centers and 23 plastic surgeons in the U nited States and Canada. Before reconstruction and at 1 year after reconstr uction, patients were evaluated by a battery of questionnaires consisting o f both generic and condition-specific surveys. Outcomes assessed included e motional well-being, vitality, general mental health, social functioning, f unctional well-being, social well-being, and body image. Baseline (preopera tive) scores and the change in scores (the difference between postoperative and preoperative scores) were compared across procedure types using t test s and analysis of covariance. Preoperative and 1-year postoperative surveys were obtained from 273 patien ts. Procedure type was reported in 250 patients, of whom 56 received implan t reconstructions, 128 pedicle TRAM flaps, and 66 free TRAM flaps. A total of 161 immediate and 89 delayed reconstructions were performed. Among women receiving immediate re-construction, significant improvements were observe d in all psychosocial variables except body image. However, no significant effects of procedure type on these changes over time existed. Similarly, de layed reconstruction patients had significant increases in emotional well-b eing, vitality, general mental health, functional well-being, and body imag e. Although the choice of reconstructive technique did not significantly im pact most of these outcomes, significant differences existed among procedur e types for three psychosocial subscales. Patients undergoing delayed expan der/implant reconstructions reported greater improvements in vitality and s ocial well-being relative to women receiving delayed TRAM procedures. By co ntrast, delayed TRAM patients noted significantly greater gains in body ima ge compared with women choosing delayed expander-implant reconstruction. The authors conclude that both immediate and delayed breast reconstructions provide substantial psychosocial benefits for mastectomy patients. Althoug h the choice of reconstructive procedure does not seem to significantly aff ect improvements in psychosocial status with immediate reconstruction, our data suggest that procedure type does have a significant effect on gains in vitality and body image for women undergoing delayed reconstruction.