To assess the possible impact of body image and other psychological factors, researchers analyzed 302 women who underwent breast reconstruction after a mastectomy between 2011 and 2015. Prior to surgery, these women completed the validated BREAST-Q questionnaire, which included several body image assessment questions. These factors were assessed to be related to the risk of postoperative complications.
Some of the body image problems identified on BREAST-Q have a significant impact on the risk of common complications after breast reconstruction. The risk of postoperative infection was increased for women with higher ratings of dissatisfaction with the way they looked in the mirror when undressed, as well as for women with lower ratings of feeling confident or attractive.
Other body image factors are associated with an increased risk of wound healing problems. Delayed healing was more common among women who were dissatisfied with the way they looked in the mirror naked and the comfort of their bras, as well as those who reported feeling less accepting of their bodies and feel “less like other women.”
Psychological factors are known to affect overall health, but little is known about their contribution to wound healing and other outcomes of surgery. Psychological assessment is increasingly used in reconstructive and plastic surgery, but often to identify risk factors for patient dissatisfaction, rather than traditional surgical complications such as infection or wound healing problems.
“[I]Identifying aspects of BREAST-Q that predict poor outcome may allow surgeons to refer patients at risk for further psychological evaluation,” wrote Dr. Losken and co-authors. not small to important complications after breast reconstruction surgery.
The findings raise the possibility that identifying and addressing these psychological factors before surgery may help reduce the risk of complications after breast reconstruction. Dr. Losken and colleagues draw a comparison with other types of efforts to reduce patient-related risk factors – eg, smoking cessation, weight loss, or “rehabilitation” interventions to reduce health risks before surgery.
The authors conclude: “Considering the well-established role that chronic stress and immune activation play in wound healing, the development of a psychological assessment tool at the point of care Caregiving – along with referrals to trained therapists – can be an important intervention to improve breast reconstruction outcomes.”