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Psychological Outcomes After Mastectomy: Implant Vs. Autologous Reconstruction
Braden N. Miller, MD, Augustine Deering III, BS, Payden Harrah, BS, Thais Polanco, MD, Roberto Martinez, MD, Charles A. Fries, MD, PhD.
UT Health San Antonio, San Antonio, TX, USA.
PURPOSE: The impact of breast reconstruction on post-mastectomy psychological outcomes is unclear. Herein, we report the first large database study evaluating depression rates after implant-based (IBR) vs autologous reconstruction (AR).
METHODS: TriNetX, a federated database of electronic medical records was used to identify 26,858 patients with breast cancer who underwent mastectomy followed by IBR or AR. Patients were propensity score matched 1:1 using logistic regression for age, race, obesity, nodal status, and metastasis status. Patients who had both IBR and AR were excluded. 3-year outcomes after diagnosis were compared.
RESULTS: 22,602 patients underwent IBR (84%), and 4,256 underwent AR (16%). After matching, the AR group had an increased risk of having any depressive diagnosis (24.9% vs 21.9%, p=0.002). When excluding patients with preexisting depression, the AR group maintained higher rates of depressives episodes (17.9% vs. 14.3%, p<0.0001), dysthymia (2.2% vs. 1.4%, p=0.009), and any depressive diagnosis (18.3% vs. 15.3%, p=0.0008), however the IBR group had higher rates of major depressive disorder (3.3% vs. 2.4, p=0.02). Immediate AR (RR 0.70, p<0.0001) and IBR (RR 0.79, p<0.0001) were associated with decreased rates of depression diagnoses compared to a delayed approach.
CONCLUSION: While a greater number of patients had new depressive symptoms after AR, patients who underwent IBR were more likely to have worse symptoms and a diagnosis of major depressive disorder.
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