Mental health outcomes following mastectomy with and without breast reconstruction: A propensity-matched analysis.

BACKGROUND

The psychological impact of breast reconstruction following mastectomy remains poorly defined. We aimed to evaluate the association between breast reconstruction, timing and type of reconstruction with mental health outcomes.

METHODS

We conducted a retrospective cohort study using the TriNetX Research Network, including 51,422 patients who underwent mastectomy for breast cancer. Patients were stratified into mastectomy only, implant-based reconstruction, or autologous reconstruction cohorts, further subdivided into immediate versus delayed reconstruction. Mental health outcomes were assessed using ICD-10 codes and prescription records. Propensity score matching was performed. Outcomes were reported as risk differences, risk ratios, and odds ratios with 95% confidence intervals.

RESULTS

After matching, mastectomy alone was associated with increased depression and antidepressant use (p < 0.05). Autologous reconstruction compared to implant-based reconstruction was associated with a decreased risk of depression after 1 year (p < 0.05). Subgroup analysis confirmed that immediate implant reconstruction was the highest risk cohort, with significantly elevated rates of depression, anxiety, mood disorder, antidepressant use, and psychotherapy. Covariates, such as ethnicity, marital status, and preexisting mental health disorders, were found to significantly increase the risk of depression following reconstruction.

CONCLUSION

Delayed autologous-based reconstruction had the lowest risk of diagnosis and utilization of healthcare resources for mental health.