Immediate versus delayed breast reconstruction A psychological answer

Summary

A survey was conducted on 50 patients who underwent breast reconstruction (25 delayed — 25 immediate) after mastectomy. Each patient was interviewed by means of a questionnaire to collect information about psychologic, psychosocial, and aesthetic results of breast reconstruction. The kind of partner's support received by the patients in making their decision to undergo breast reconstruction was also analyzed. The patients were furthermore asked to speak about their mood relative to the time of mastectomy, and to describe (for immediate group) if the awareness of going into the operating room with a therapeutic program that included the synchronous reconstruction of the breast after mastectomy had any effect on their general mood. Afterwards, the patients were asked to draw a human figure. The Karen Machower projective test was evaluated using the Witkin rating scale. Furthermore each patient received a personality test (M.M.P.I.). Out of patients, 39 (78% of cases) replied with a completed questionnaire. Results showed that long-term adjustment does not appear to be different between the groups. No differences were found on MMPI, Human Figure Test, degree of satisfaction and acceptance of endoprosthesis. In the immediate group, 17 cases (85%) said their partners were in favor of reconstruction, 3 were indifferent, and none were against. In the delayed group, 6 cases reported receiving positive support from their partner as opposed to 9 cases where was against it and in 10 cases they were indifferent (X = 14.39, df=1, in favor vs. indifferent/against, p<0.0005). All the patients of the immediate group report having experienced strong psychological relief in knowing that they would undergo immediate breast reconstruction. All they would suggest, regardless of their satisfaction with esthetic results, mastectomized women to undergo breast reconstruction; as for the delayed group, 19 said they would always suggest and 6 mentioned it depended on the cases (Exact Fisher's Test, p<0.05). This study underlines that immediate reconstructive surgery does not present any particular contraindication for acceptance of surgical outcome. Moreover, we can suppose that delayed breast reconstruction may trigger anxiety and distress during the period of mastectomy in the patients and in the partners themselves.