The psychological impacts of post-mastectomy breast reconstruction: a systematic review.

Background: While it is often presumed that undergoing breast reconstruction (BR) after mastectomy has positive psychosocial effects, a comprehensive review of current knowledge on the topic is to date absent. The aim of this systematic review is to summarize the available literature on the effects of BR on postoperative psychological distress.

Methods: A systematic review of the literature was performed using PubMed, Google Scholar, EMBASE, PSYCinfo, and Web of Science. Inclusion criteria included clinical studies of patients who underwent BR post-mastectomy with psychological distress assessments as primary outcomes. Articles were independently reviewed and assessed for bias and evidence quality. Analyses were performed among patients receiving mastectomy alone (MA) versus mastectomy with breast reconstruction (MBR), immediate versus delayed mastectomy, and implant-based versus autologous reconstruction.

Results: Ninety-nine studies published from 1980-2021 met inclusion criteria and were reviewed. Twenty-six (26.3%) studies compared patients who underwent MBR to those who underwent MA. Of these, 18 (69.2%) found that MBR had superior effects on psychologic outcomes, 6 (23.1%) found no differences, and 2 (7.7%) found negative psychologic effects relative to MA. Fourteen (14.1%) studies compared immediate versus delayed BR, of which 4 (28.6%) found that immediate BR had superior psychologic outcomes while 10 (71.4%) found no significant differences. Sixteen (16.2%) studies compared autologous versus implant-based reconstruction. Eight (50.0%) of these reported patients with autologous BR were more satisfied with breast appearance.

Conclusions: While findings are not uniform, the majority of studies found that BR following mastectomy improves psychologic outcomes, with a possible benefit of immediate over delayed BR. Future studies should determine if BR type has an effect on psychological distress.