title: A prospective study of mastectomy patients with and without delayed breast reconstruction: long-term psychosocial functioning in the breast cancer survivorship period.
abstract: BACKGROUND
  For women who have mastectomy, breast reconstruction is an option which may improve psychosocial functioning. The purpose of this study was to evaluate changes in psychosocial functioning over a long follow-up period after mastectomy, specifically examining the differences between those with mastectomy alone and those who underwent postmastectomy delayed breast reconstruction (DBR).
  
  
  METHODS
  This was a prospective longitudinal survey study of women with mastectomy in which a repeated measures design was used to compare psychosocial function scores over 3 timepoints: 1) pre-mastectomy; 2) one year post-mastectomy; and 3) long-term post-mastectomy (mean 6.3 years). In addition, psychosocial functioning was compared between the mastectomy alone group and the group who elected for DBR.
  
  
  RESULTS
  67 women who completed questionnaires at all three time points were included. The long-term follow-up time post-mastectomy was 75.2 months (6.3 years). Twenty-eight women (41.8%) underwent DBR in the study period. For the entire cohort, between one-year and long-term post-mastectomy, there were significant improvements in scores for body concerns (P = 0.03), cancer-related distress (P = 0.01), and total distress (P = 0.04). At long-term follow-up, women with DBR had significantly higher levels of total distress (P = 0.01), obsessiveness (P = 0.03), and cancer-related distress (P = 0.02) compared to those with mastectomy alone. There were no differences in quality of life between the two groups at any time point.
  
  
  CONCLUSIONS
  Psychosocial functioning improves over time in patients treated with mastectomy in the long-term breast cancer survivorship period, which may be related to the effect of time post-treatment, rather than an effect of choice for or against DBR.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Faculty of Medicine, Department of Surgery in the Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Metcalfe
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
authors.forename: May-Lynn
authors.initials: ML
authors.lastname: Quan
authors.forename: Claire
authors.initials: C
authors.lastname: Holloway
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Bagher
authors.forename: John
authors.initials: J
authors.lastname: Semple
mesh_terms: D000223:Adaptation, Psychological; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*
keywords: Breast cancer surgery; Cognitive and emotional status; Plastic surgery