title: Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study.
abstract: BACKGROUND
  Substantial complication rates after postmastectomy breast reconstruction (BR) in breast cancer patients have been reported. Few studies have reported on the resulting psychological distress (PD) and satisfaction with the aesthetic result in relation to postoperative complications after completion of implant or DIEP flap BR. The present study investigated whether women were able to recover from complication related distress in the long term.
  
  
  METHODS
  PD was prospectively measured using questionnaires regarding anxiety, depression and cancer distress. Eligible patients completed questionnaires before BR (T0, n = 144), after one month (T1, n = 139) and after completion of BR, approximately 21 months after initial reconstructive surgery (T2, n = 119). Satisfaction with the aesthetic result was assessed 21 months after BR. Data concerning complications, subsequent additional surgery and total reconstruction failure up to T2 were collected from the medical records. Analyses were performed using multi-level regression analyses correcting for age.
  
  
  RESULTS
  One or more complications occurred in 61 patients (42%) and 50 women required subsequent surgery (35%). In time, mean PD significantly declined towards baseline scores independent of complications. However, a total reconstruction failure (n = 10) was significantly associated with a large temporary increase in depression scores. After additional surgery due to complications patients were less satisfied with aesthetic outcome, although patient satisfaction was independent of PD.
  
  
  CONCLUSIONS
  PD outcomes generally declined to normal levels after completion of the entire BR course. Patients experiencing a total reconstruction failure reported more depression after this loss, but in the long term recovered to the same level as women without complications. These findings indicate that women generally can cope efficiently with these serious adverse events, even if they were less satisfied with the aesthetic result.
authors.affiliation: Department of Psychiatry, section of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Reinier
authors.identifier: http://orcid.org/0000-0002-7772-0394
authors.initials: R
authors.lastname: Timman
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Gopie
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: J Nick
authors.initials: JN
authors.lastname: Brinkman
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Kleijne
authors.affiliation: Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Seynaeve
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.|Breast Clinic, Albert Schweitzer Hospital, Rotterdam, the Netherlands.
authors.forename: Marian B E
authors.initials: MB
authors.lastname: Menke-Pluymers
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Moniek M
authors.initials: MM
authors.lastname: Ter Kuile
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: Tibben
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Marc A M
authors.initials: MA
authors.lastname: Mureau
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000523:psychology; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*; D013524:Surgical Flaps