PURPOSE: The impact of breast reconstruction on post-mastectomy psychological outcomes is unclear. Herein, we report the first large database study evaluating depression rates after implant-based (IBR) vs autologous reconstruction (AR).
METHODS: TriNetX, a federated database of electronic medical records was used to identify 26,858 patients with breast cancer who underwent mastectomy followed by IBR or AR. Patients were propensity score matched 1:1 using logistic regression for age, race, obesity, nodal status, and metastasis status. Patients who had both IBR and AR were excluded. 3-year outcomes after diagnosis were compared.
RESULTS: 22,602 patients underwent IBR (84%), and 4,256 underwent AR (16%). After matching, the AR group had an increased risk of having any depressive diagnosis (24.9% vs 21.9%, p=0.002). When excluding patients with preexisting depression, the AR group maintained higher rates of depressive episodes (17.9% vs. 14.3%, p<0.0001), dysthymia (2.2% vs. 1.4%, p=0.009), and any depressive diagnosis (18.3% vs. 15.3%, p=0.0008), however the IBR group had higher rates of major depressive disorder (3.3% vs. 2.4, p=0.02). Immediate AR (RR 0.70, p<0.0001) and IBR (RR 0.79, p<0.0001) were associated with decreased rates of depression diagnoses compared to a delayed approach.
CONCLUSION: While a greater number of patients had new depressive symptoms after AR, patients who underwent IBR were more likely to have worse symptoms and a diagnosis of major depressive disorder.