title: Breast reconstruction after mastectomy: does it decrease depression at the long-term?
abstract: BACKGROUND
  Depression is associated with breast cancer survivors in 22%. Although breast reconstruction (BR) is intended to provide psychological improvements such as reducing depression, literature is inconclusive and without long-term follow-up. The objective is to evaluate the impact of BR after breast cancer related mastectomy on the long-term depression risk and assess predictive factors for depression.
  
  
  METHODS
  Women who underwent a curative mastectomy between 1999 and 2009 were included. After a mean follow-up of more than 6 years after operation, the Beck Depression Inventory-13 (BDI-13) evaluated depressive symptoms. Multivariable regression analysis provided predictors for depression.
  
  
  RESULTS
  A total of 139 patients, 34 (24.5%) with and 105 (75.5%) without BR, were analyzed. Seventy-seven patients (48.2%) were at high risk for mild (n=58), moderate (n=5) or severe (n=4) depression. There was a trend for slightly better BDI-13 outcomes for women who underwent BR (2 vs. 4; P=0.06). Living alone [odds ratio (OR): 2.16; P=0.04], low educational level (OR: 3.70; P<0.01) and adjuvant hormonal/endocrine-therapy (OR: 2.36; P=0.02) were associated with an increased depression risk.
  
  
  CONCLUSIONS
  BR has no clear influence on depressive symptoms on the long-term. Predictive factors should alert clinicians to assess depressive symptoms in specific breast cancer patients during follow-up.
authors: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands ;
authors: Christel Aurora Louise
authors: CA
authors: de Raaff
authors: Department of Anesthesiology, LU Medical Center, Leiden, the Netherlands ;
authors: Eveline Anne-Jet
authors: EA
authors: Derks
authors: Department of Clinical Epidemiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands ;
authors: Bart
authors: B
authors: Torensma
authors: Department of Psychiatry, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;; Department of Psychiatry, VU Medical Center, Amsterdam, the Netherlands.
authors: Adriaan
authors: A
authors: Honig
authors: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands ;
authors: Bartholomeus Cornelius
authors: BC
authors: Vrouenraets
keywords: Depression; breast neoplasms; breast reconstruction (BR); depressive disorder; mammaplasty; mastectomy