Ann Plast Reconstr Surg | Volume 2, Issue 1 | Research Article | Open Access
Diaa Othman*
Sheffield Teaching Hospitals, Sheffield, UK
*Correspondance to: Diaa Othman
Fulltext PDFBackground: Breast cancer is the most prevalent cancer in women and has a lifetime incidence of one in nine. Mastectomy may be accompanied by neo-adjuvant and adjuvant therapy. Breast reconstruction is an integral part of treatment of breast cancer, and could be performed either at the time of mastectomy, immediate breast reconstruction (IBR), or at a later stage, delayed breast reconstruction (DBR). Outcomes such as psychosocial morbidity, aesthetics and complications rates may differ between the two approaches. Although there is no universal consensus on superiority of either approach, there is an evidence to support the fact that the aesthetic result, psychosocial effect, and cost of breast reconstruction are better with immediate reconstruction, but the risk of surgical complications is less with delayed reconstruction.
Objectives: To review and analyze the current literature comparing the psycho-social outcomes comparing both approaches; IBR and DBR. Search
Methods: Online search was performed in August 2015 using Pubmed, Embase and Medline databases, to identify articles related to breast reconstruction. All articles assessing psycho-social and other related outcomes were collected and reviewed. Only articles reported in English were included. Data Collection and Analysis: The first author screened papers, extracted trial details and performed the literature review and analysis. Post-operative morbidity and mortality were not addressed. Main
Results: Psychological distress is evident among women regardless of reconstruction or timing of reconstruction. Psycho-social outcomes are variable, and include quality of life, sexual functioning, cancer-related distress, body image, depression, and anxiety. There is a greater body of evidence, though unreliable, to support the relatively higher psychosocial outcomes in IBR group compared to the DBR, and in the reconstruction group compared to the non-reconstruction group. However, recently developing evidence is also suggesting relative superiority of the DBR in certain aspect of these variable psycho- social outcomes. In the literature search, only one Randomized Clinical Trial (RCT) compared the IBR to the DBR. The data suggest that women presenting for mastectomy and breast reconstruction at different stages of reconstruction have different baseline psycho-social baseline. Such data, and encouragement for further larger prospective ones, will improve our understanding in patient selection and expectation, and decision making on appropriate timing of reconstruction. However, this must be put into the context of the clinical needs of the patient and logistic demand of the system managing these patients.
Othman D. Immediate Versus Delayed Breast Reconstruction: A Literature Review and Analysis of Psychosocial Outcomes. Ann Plast Reconstr Surg. 2018;2(1):1009.