The psychological impact of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer

In this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202 patients from different hospitals in the South-West of the Netherlands between 2007-2012. With semi-structured interviews the motives to opt for breast reconstruction were qualitatively investigated. The impact of breast reconstruction was further investigated with psychological questionnaires from baseline to the end of the breast reconstruction procedure (mean follow-up of 21 months). The psychological outcomes after breast reconstruction that were investigated were: body image, satisfaction with the partner relationship and the sexual relationship, general anxiety and depression, cancer distress, and general mental and physical health. In general, the psychological outcomes after breast reconstruction were acceptable, however a subgroup of women experienced psychological adjustment problems. A percentage of 20-30% remained having problems with changes in their body image and the impact on the intimate partner relationship. Women at risk for psychological adjustment problems were younger women, those with significant cancer distress, women who experienced complications after surgery, particularly if the breast reconstruction failed, and women who underwent bilateral prophylactic mastectomy because of an increased hereditary risk to develop breast cancer.KWF KankerbestrijdingUBL - phd migration 201

Surveillance for hereditary cancer: does the benefit outweigh the psychological burden?--A systematic review

Individuals at risk for developing hereditary cancer are offered surveillance in order to improve the prognosis. An important question is whether the benefit of surveillance outweighs the psychological burden. In this review, we evaluated all studies that investigated psychological distress and the quality of life in individuals under surveillance for hereditary cancer of the breast, ovarian, prostate, pancreas, colorectum, melanoma, and various rare syndromes such as familial adenomatous polyposis, Li-Fraumeni and Peutz-Jeghers syndrome. Thirty-two studies were identified. Surveillance for most hereditary cancers was associated with good psychological outcomes. However, surveillance of individuals at high risk for developing multiple tumors appeared to be associated with increased distress and a lower quality of life. Common factors associated with worse psychological outcomes included a personal history of cancer, female gender, having a first degree relative with cancer, negative illness perceptions and coping style. The use of a simple screening tool to identify distressed individuals is recommended.Hereditary cancer genetic

Predictors of outcome in a cohort of women with chronic pelvic pain - a follow up study

Gynecolog

Impact of delayed implant and DIEP flap breast reconstruction on body image and sexual satisfaction: a prospective follow-up study

Hereditary cancer genetic

Aesthetic outcome after implant and DIEP flap breast reconstruction: An exploratory, prospective comparison of 25 cases

Hereditary cancer genetic

Information-seeking behaviour and coping style of women opting for either implant or DIEP-flap breast reconstruction

Hereditary cancer genetic

The short-term psychological impact of complications after breast reconstruction

Objectives: Few studies have focused on the psychological impact of postoperative complications after breast reconstruction (BR). As postoperative complications after BR usually lead to a prolonged recovery time and sometimes require additional surgery, the short-term impact on distress was investigated. Methods: Pre- and postoperatively, psychological questionnaires were sent to 152 women who underwent either implant BR or deep inferior epigastric artery perforator flap BR (DIEPBR). In addition, patients and physicians' reports of postoperative complications during the first 4-6 weeks after BR were scored. The course of anxiety, depression and cancer-specific distress, and the effect of complications on distress were investigated. Results: Implant BR patients reported decreased anxiety after surgery, and both groups reported reduced cancer-specific distress after surgery. However, depressive symptoms tended to increase after DIEPBR. If complications occurred, both reconstruction groups reported increased depressive and anxiety symptoms, and DIEPBR patients even had depressive symptoms of clinical concern. A significant number of patients with complications reported alarming levels of distress. Timing and laterality were not significantly correlated with distress. Conclusions: Complications after BR have a significant impact on emotional well-being shortly after surgery. As distress affects quality of life and health outcomes, it is of great importance to offer psychological support to these patients. Distress can be evaluated by monitoring the emotional impact of BR during post-surgery consults, or with the standard use of short psychological questionnaires that patients can complete at home. Copyright © 2011 John Wiley & Sons, Ltd.Hereditary cancer genetic

Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer

The outcome of bilateral prophylactic mastectomy with breast reconstruction (BPM-IBR) in healthy BRCA1/2 mutation carriers can be potentially burdensome for body image and the intimate relationship. Therefore, in the current analysis the impact on body image, sexual and partner relationship satisfaction was prospectively investigated in women opting for BPM-IBR as well as cancer distress and general quality of life. Healthy women undergoing BPM-IBR completed questionnaires preoperatively (T0, n = 48), at 6 months (T1, n = 44) and after finishing breast reconstruction (median 21 months, range 12-35) (T2, n = 36). With multi-level regression analyses the course of outcome variables was investigated and a statistically significant change in body image and/or sexual and partner relationship satisfaction was predicted by baseline covariates. Body image significantly decreased at T1. At T2 sexual relationship satisfaction and body image tended to be lower compared to baseline. The overall partner relationship satisfaction did not significantly change. At T2, 37 % of the women reported that their breasts felt unpleasantly, 29 % was not satisfied with their breast appearance and 21 % felt embarrassed for their naked body. Most body image issues remained unchanged in 30 % of the women. A negative body image was predicted by high preoperative cancer distress. BPM-IBR was associated with adverse impact on body image in a substantial subgroup, but satisfaction with the overall sexual and partner relationship did not significantly change in time. The psychosocial impact of BPM-IBR in unaffected women should not be underestimated. Psychological support should ideally be integrated both before and after BPM-IBR.Hereditary cancer genetic

Women's motives to opt for either implant or DIEP-flap breast reconstruction

Hereditary cancer genetic