The Emotional Impact of Breast Reconstruction
A new study by a team of Minnesota researchers suggests that women who undergo reconstructive surgery after a mastectomy may suffer more emotional side effects than women who opt for mastectomy alone.
However, this runs counter to the findings of an earlier University of Michigan study that concluded breast reconstruction can have significant psychological and emotional benefits.
The Minnesota study, published in the journal Cancer by researchers at the Park Nicollet Clinic in Minneapolis, included 198 women who underwent breast cancer surgery between 1995 and 1997. Of these women, slightly more than half (52 percent) underwent breast-conserving surgery (lumpectomy), 28 percent had mastectomy alone, and 20 percent had reconstruction following mastectomy.
Before each of their surgeries, Dr. Mary Nissen and colleagues asked the patients to fill out a quality-of-life questionnaire that assessed uncertainty, mood disturbance, and other factors affecting emotional well-being. The patients were then given similar questionnaires during a two-year follow-up period.
After their surgeries, the lumpectomy and reconstruction patients scored significantly worse than the mastectomy patients in terms of differences in mood disturbance and emotional well-being. For the reconstruction patients, Nissen's team found, these emotional side effects persisted for up to two years.
The authors suggested that the reconstruction patients may not have fared as well emotionally because of greater postoperative pain involved in their procedure, as well as a significantly longer recovery time that may have taken more time away from usual activities.
Conversely, a separate study led by researchers at the University of Michigan found that breast reconstruction after mastectomy can have significant psychological and emotional benefits for breast cancer patients.
Writing in the journal Plastic and Reconstructive Surgery, Dr. Edwin Wilkins of the University of Michigan and colleagues also determined that women who had immediate reconstruction at the time of their mastectomy had more of a psychological boost than those who waited to have the procedure until a later date.
Interestingly, the researchers further concluded that the specific type of reconstructive surgery-saline or silicone implants vs. using the patient's own tissue-made little difference for a woman's psychological recovery. "We saw emotional benefits from both types of procedures," said Wilkins. "Quite frankly, the actual type of reconstruction technique often meant more to the surgeon than to the patient-and usually reflected the surgeon's own particular experience with a procedure."
The Michigan researchers evaluated 250 mastectomy patients at 12 medical centers in the U.S. and Canada. Two separate surveys were given to each patient to assess their emotional state-the first a few days before the reconstructive surgery and the second a year after the surgery. The surveys evaluated each woman's emotional well-being, vitality, general mental health, social functioning, and body image.
After reconstruction, the women were also asked about their satisfaction with their surgery. The results were then compared among the women who chose different reconstruction approaches and different timing for their reconstructive surgeries.
Most of the women (184) had breast reconstructions from their own tissue, while the rest had artificial tissue expanders or implants filled with saline or silicone. More than two-thirds had reconstruction at the same time as their mastectomy surgery.
According to the authors, the study confirmed that any kind of reconstruction gave women a psychological and emotional boost during their recovery. But they added that the timing of the reconstruction did indeed make a difference.
The researchers found that the biggest psychological boost was experienced by women who opted for reconstruction during the same operation as their mastectomy, rather than waiting until a later date for the additional surgery. "The largest effect seemed to occur in those who came out of mastectomy surgery with a new breast already in place," said Wilkins. "But even patients who waited experienced a substantial positive upswing."
Emotional and psychological benefits accrued regardless of the type of reconstruction performed. "The true objective for the reconstruction should be to produce the quality of life benefits that matter most to the patient," Wilkins said. "And simply having a breast reconstruction, rather than the specific type of surgery, is what mattered most."
SOURCES:
Cancer, April 1, 2001; 91:1238-1246
Plastic and Reconstructive Surgery, October 2000
University of Michigan Health System (http://www.umich.edu)
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