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The Impact Of A Psychiatric Diagnosis On Patient-reported Satisfaction And Quality Of Life In Post-mastectomy Breast Reconstruction
Meghana G. Shamsunder, MPH, Thais O. Polanco, Robert J. Allen, Jr., MD, Collen M. McCarthy, MD, Evan Matros, MD, MMSc, Joseph H. Dayan, MD, Joseph J. Disa, MD, Peter G. Cordeiro, MD, Babak J. Mehrara, MD, Andrea L. Pusic, MD, MMSc, Jonas A. Nelson, MD.
Memorial Sloan Kettering, New York, NY, USA.

Background:
A psychiatric diagnosis commonly affects patients with a cancer diagnosis and are understood to significantly impact quality of life (QOL). This study aims to demonstrate psychiatric diagnosis’ impact and influence satisfaction and QOL following postmastectomy breast reconstruction (PMR).
 
Methods:
Women who underwent either implant or autologous-based PMR and completed at least one BREAST-Q from 2009-2017 were included. Psychiatric diagnosis were categorized into 11 general categories based on DSM-IV criteria. Mean and median scores for satisfaction with breasts were cross-sectionally analyzed preoperatively and postoperatively at six months – three-years using non-parametric tests.
 
Results:
Of 3268 included patients, 1860 (56.92%) had a psychiatric diagnosis. Fifty-two percent of patients had one psychiatric diagnosis, 28.98% had two psychiatric diagnosis, and 18.92% had three or more psychiatric diagnosis. Anxiety disorders were the most prevalent (n=1398[75.16%]), followed by mood disorders (n= 731[39.3%]). At each time-point, a patient with a psychiatric diagnosis were significantly less satisfied with their breasts compared to patients without psychiatric diagnosis (p<0.01,Table 1). Satisfaction scores progressively decreased as the number of psychiatric diagnosis per patient increased. Patients with two psychiatric diagnosis were significantly less satisfied in the postop period compared to patients without a psychiatric diagnosis while patients with three or more psychiatric diagnosis were significantly less satisfied compared to patients without a psychiatric diagnosis and patients with one psychiatric diagnosis in the one to three-year postop period (all p<0.05).  A psychiatric diagnosis were associated with lower physical-wellbeing of the chest scores preoperatively and postoperatively.
 
Conclusions:
Psychiatric diagnosis have the potential to negatively impact breast satisfaction and physical wellbeing in reconstructive patients. Such patients may benefit from directed psychiatry referrals to offer improved treatment for their psychiatric condition, which will potentially impact multiple aspects of the patients life and satisfaction with her cancer and reconstructive care.


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