title: Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction.
abstract: BACKGROUND
  In this study, we report on the changes in psychosocial functioning over 1 year following breast cancer surgery in 3 groups of women, including those with mastectomy alone, those with mastectomy and immediate reconstruction, and those with delayed reconstruction.
  
  
  METHODS
  Women with breast cancer at 2 teaching hospitals in Ontario who were undergoing mastectomy alone, mastectomy with immediate reconstruction, or delayed reconstruction were asked to complete a battery of psychosocial questionnaires at their preoperative appointment and 1 year following surgery.
  
  
  RESULTS
  A total of 190 women consented to participate in the study and completed the presurgical questionnaires. There were no presurgical differences between the 3 groups in quality of life, anxiety, depression, or sexual functioning. However, women who were undergoing delayed breast reconstruction (i.e., already had a mastectomy) had higher levels of body stigma (P = 0.01), body concerns (P = 0.002), and transparency (P = 0.002) than women who were undergoing mastectomy alone or mastectomy with immediate reconstruction. Of these women, 158 (83.2%) completed the 1-year follow-up. There were no significant differences in any of the psychosocial functioning scores between the 3 groups.
  
  
  CONCLUSIONS
  Contrary to the assumed psychological benefits of breast reconstruction, psychological distress was evident among women regardless of reconstruction or timing of reconstruction. Further, psychosocial functioning (including quality of life, sexual functioning, cancer-related distress, body image, depression, and anxiety) was not different at 1-year postsurgery between women with mastectomy alone, mastectomy with immediate reconstruction, and delayed reconstruction. These results suggest that women need psychosocial support after breast cancer diagnosis, even if they have breast reconstruction.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. Kelly.metcalfe@utoronto.ca
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Metcalfe
authors.forename: John
authors.initials: J
authors.lastname: Semple
authors.forename: May-Lynn
authors.initials: ML
authors.lastname: Quan
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.forename: Claire
authors.initials: C
authors.lastname: Holloway
authors.forename: Mitch
authors.initials: M
authors.lastname: Brown
authors.forename: Bethanne
authors.initials: B
authors.lastname: Bower
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D004644:Emotions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors