Assessing the Relationship between Breast Reconstruction and Psychiatric Comorbidities Among Breast Cancer Patients

Goals/Purpose: Breast cancer patients experience significant changes in psychosocial and sexual health after undergoing mastectomies. Although breast reconstruction (BR) has shown to improve psychosocial outcomes, the risk of complications related to their reconstruction presents both physical and psychological challenges. Previous studies have focused on the psychosocial effect of BR and impacts on quality of life. However, there is a paucity of information regarding the prevalence of psychiatric disorders after patients undergo various BR procedures. In this study, the authors aimed to (i) compare postoperative onset of psychiatric disorders among previously healthy patients undergoing different forms of breast reconstruction (ii) identify the probability of a psychiatric outcome among all BR patients based on procedure.

Methods/Technique: PearlDiver, a national database encompassing private payers with 153 million unique patients, was queried from 2010-2020. Post-mastectomy patients with a history of breast cancer or increased risk of breast cancer and those who underwent BR were included utilizing International Classification Codes 9 and 10. Prevalence of each disorder, timing of diagnosis (preoperative or postoperative) and differences in postoperative prevalence were reviewed. Retrospective analysis was performed, and binomial outcomes were compared using Pearson’s Chi-square. Logistic regression was used to identify procedures associated with developing a psychiatric disorder up to 3 years post-operatively.

Results/Complications: Preoperatively, anxiety and depression were the most prevalent diagnoses between all surgeries. Postoperatively, anxiety and depression were also the most prevalent disorders among those with no prior psychiatric condition. Among patients with no pre-operative psychiatric disorder, mastectomy alone (34.6%) and implant-based BR (34.1%) were associated with a significantly increased onset of a comorbid psychiatric disorder when compared to DIEP reconstructions (P<0.01) (Table 2). Using logistic regression analysis of all breast cancer patients up to 3 years postoperatively, type of surgery was predictive of specific psychiatric diagnosis (Table 1).

Conclusion: Anxiety and depression were the most prevalent diagnoses among all patients pre-operatively and among patients with no prior psychiatric comorbidity post-operatively. When compared to other surgery cohorts, both immediate and delayed DIEP reconstructions were associated with a lower onset of a psychiatric disorder among patients with no prior diagnosis. All procedures were associated with an increased probability of a post-operative anxiety diagnosis. Interestingly, regression analysis further showed that only mastectomy alone was not significantly predictive of developing trauma- and stress-related disorders, possibly suggestive of the inherent challenges faced by patients undergoing complex BR. Further research is necessary to better understand the possible interplay between breast reconstruction outcomes and psychiatric comorbidities.