Closing the Loop on Revision: The Impact of Emotional Well-Being on Elective Revision After Breast Reconstruction.

Abstract

A diagnosis of breast cancer has a significant impact on a patient's physical and emotional health. Breast reconstruction improves quality of life and self-esteem following mastectomy. However, many patients undergo additional elective revision procedures after reconstruction. This study aims to assess the relationship between perioperative emotional well-being and elective revisions in breast reconstruction. A retrospective review was performed of patients who underwent breast reconstruction with a single surgeon from January 2007- December 2017. Revision procedures were defined as additional operations that fall outside the index reconstructive plan. Medical records were reviewed for a history of generalized anxiety disorder (GAD) and/or major depressive disorder (MDD). Multivariate analysis was performed to identify factors associated with revision. A total of 775 patients undergoing breast reconstruction were included, of which 121 (15.6%) underwent elective revision. Overall, a history of any psychiatric history (p<0.001), depression alone (p=0.001%), and GAD and depression together (p=0.003) were significantly associated with revision surgery. On multivariate logistic regression controlling for comorbidities and reconstruction modality, depression alone and GAD and depression together were significantly associated with increased likelihood of revision surgery (OR 3.20, p<0.001; OR 2.63, p<0.001). Peri-operative emotional well-being and reconstruction modality impact the rate of secondary revision surgery. An understanding of the surgical and patient-related risk factors for revision can provide more informed patient-decision making and improve surgical planning.