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Body image issues increase risk of complications post breast reconstruction surgery, new study finds

TO assess the possible impact of body image and other psychological factors, the researchers analysed 302 women undergoing post-mastectomy breast reconstruction from 2011 to 2015. | Reuters

TO assess the possible impact of body image and other psychological factors, the researchers analysed 302 women undergoing post-mastectomy breast reconstruction from 2011 to 2015. | Reuters

Published Mar 1, 2022

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Plastic or cosmetic surgery is the technical name for a procedure undertaken by a person for health reasons or for accentuating their looks.

While some undergo surgeries like mastectomy to prevent the risk of cancer in breasts, others opt for silicone implants to enhance them. A recent study found that psychological factors have an implication on the complications post-breast surgery.

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The study, published in “Plastic and Reconstructive Surgery”, the official medical journal of the American Society of Plastic Surgeons (ASPS), found that psychological factors, especially related to body image, may affect the risk of complications after breast reconstruction surgery.

“Patients with lower preoperative body satisfaction were found to have increased incidence of infections and delayed wound healing,” according to the new research by ASPS Member Surgeon Albert Losken of Emory University School of Medicine, Atlanta, and colleagues.

The researchers suggested that psychological screening and intervention might help to identify patients at higher risk for complications, and potentially alter the course to reduce the risk of complications in women undergoing breast reconstruction after mastectomy for breast cancer.

To assess the possible impact of body image and other psychological factors, the researchers analysed 302 women undergoing post-mastectomy breast reconstruction from 2011 to 2015.

Before surgery, the women completed the validated BREAST-Q questionnaire, which included several questions assessing body image. These factors were evaluated for association with the risk of postoperative complications.

Several body image issues identified on the BREAST-Q had a significant impact on the risk of common complications after breast reconstruction.

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The risk of postoperative infections was increased for women with higher ratings for dissatisfaction with how they looked in the mirror unclothed, as well as for those with lower ratings for feeling self-confident or attractive.

Other body image factors were linked to an increased risk of problems with wound healing. Delayed wound healing was more common in women who were less satisfied with how they looked in the mirror unclothed and how comfortably their bras fit, and well as those who reported feeling less accepting of their body and feeling “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.

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Psychological assessments are increasingly used in plastic and reconstructive surgery, but usually to identify risk factors for patient dissatisfaction, rather than traditional surgical complications like infections or problems with wound healing.

"(I)dentifying aspects of the BREAST-Q that predict poor outcomes may allow surgeons to refer at-risk patients for further psychological assessment,“ Dr Losken and co-authors wrote. The findings suggested that items related to body image, self-confidence, and attractiveness could have a significant impact on important complications after breast reconstruction surgery.

The findings raised the possibility that identifying and addressing these psychological factors before surgery might help to reduce the risk of complications after breast reconstruction.

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Dr Losken and colleagues drew a comparison with other types of efforts to reduce patient-related risk factors – for example, smoking cessation, weight loss or “pre-habilitation” interventions to reduce health risks before surgery.

The authors concluded by saying, “Considering the well-established role that chronic stress and immune-activation play in wound-healing, development of a point-of-care psychological assessment tool – coupled with referral to trained therapists – may represent an important intervention to improve breast reconstruction outcomes.”

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