World Journal of Surgery

, Volume 42, Issue 7, pp 2076–2085 | Cite as

Depression Induced by Total Mastectomy, Breast Conserving Surgery and Breast Reconstruction: A Systematic Review and Meta-analysis

  • Chengjiao Zhang
  • Guangfu Hu
  • Ewelina Biskup
  • Xiaochun Qiu
  • Hongwei Zhang
  • Haiyin Zhang
Scientific Review



To carry out a systematic review and meta-analysis of the literature to determine whether different type of surgery induces different depression occurrence in female breast cancer at mean time more than 1-year term postoperatively.


A systematic literature search of PubMed, Web of Science, EMBASE, OvidSP, EBSCO and PsycARTICLES was conducted. Observational clinical studies that compared the depression incidence in different surgery groups and presented empirical findings were selected.


Sixteen studies met the inclusion criteria, including 5, 4, 2 and 5 studies compared depression between total mastectomy (TM) and breast conserving therapy (BCS), TM and breast reconstruction (BR), BCS and BR, or among all three groups (TM, BCS and BR), respectively. Only 1 of 5 studies, which subjected to multivariate analysis of depression in female breast cancer, reported a statistically significant effect of type of surgery on depression occurrence. Our meta-analysis showed no significant differences among the three types of surgery, with BCS patients versus TM patients (relative risk [RR] = 0.89, 95% confidence interval [CI] 0.78–1.01; P = 0.06), BR patients versus TM patients (RR = 0.87, 95% CI 0.71–1.06; P = 0.16) and BCS patients versus BR patients (RR = 1.10; 95% CI 0.89–1.35; P = 0.37), respectively.


Our study showed that there were no statistically significant differences concerning the occurrence of depressive symptoms in breast cancer patients as a consequence of TM, BCS or BR at mean time more than 1-year term postoperatively.



Grant support for the research reported: General Scientific Research foundation of Shanghai Mental Health Center Grants 2017-YJ-10; Youth Fundation of Zhongshan Hospital Grants 2016ZSQZ54.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts, either perceived or real, with respect to this article.

Supplementary material

268_2018_4477_MOESM1_ESM.doc (102 kb)
Supplementary material 1 (DOC 101 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of Psychological Measurement, Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Department of Psychiatry, Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.Department of Breast SurgeryShanghai Huangpu District Central HospitalShanghaiChina
  4. 4.Department of General Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
  5. 5.Shanghai University of Medicine and Health SciencesShanghaiChina
  6. 6.Department of Internal Medicine, University Hospital of BaselUniversity of BaselBaselSwitzerland
  7. 7.Medical School LibraryShanghai Jiao Tong University School of MedicineShanghaiChina

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