Somatoform Disorders Affect Decision-making of Breast Reconstruction Post-Mastectomy of Breast Cancer Patients: A Comparative Hazard Analysis.

BACKGROUND

Somatoform disorders (SDs), including somatic symptom disorder and body dysmorphic disorder, are increasingly recognized for their impact on surgical decision-making. Their influence on breast reconstruction (BR) timing and type following mastectomy remains underexplored.

METHODS

Using the TriNetX National Health Research Network, we conducted a retrospective cohort study of 192,618 breast cancer patients who underwent mastectomy between 2005 and 2023. Patients were stratified into cohorts based on the presence or absence of a documented SD diagnosis (ICD-10: F45). Propensity score matching was applied to balance baseline characteristics. Primary outcomes included BR timing (immediate and delayed) and method (autologous and implant-based).

RESULTS

Among the cohort, 3067 (1.6%) had an SD diagnosis. Immediate BR rates were not significantly different between groups. However, patients with SDs were significantly more likely to undergo delayed BR: HR = 1.59 (95% CI 1.21-2.09) for autologous and HR = 1.24 (95% CI 1.06-1.45) for implant-based reconstruction. Overall BR rates within two years were modestly higher in the SD group.

CONCLUSIONS

While SDs do not deter patients from choosing immediate BR, they are associated with delayed reconstruction, likely reflecting psychological factors, such as decisional conflict, risk sensitivity, and body image concerns. Integrating mental health assessment into preoperative counseling may facilitate more timely and individualized BR decisions. Further research should examine long-term satisfaction and outcomes in this population.

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