Breast reconstruction may not boost well-being

Women who have a mastectomy after being diagnosed with breast cancer seem have a similar quality of life in the long term whether they have breast reconstruction surgery or not, a research review suggests.

Many women who undergo mastectomy have breast reconstruction performed, either at the same time as the mastectomy or at a later point. Breast reconstruction is generally thought to improve women's quality of life in the long run, and some studies have suggested as much.

But in the new review, which looked at 33 studies of mastectomy patients' own reports of their long-term well-being, researchers found that overall, women fared similarly whether or not they had reconstruction.

Of 11 studies of quality of life - measured by factors like physical functioning, emotional well-being and social life - seven found no differences, on average, between women who had reconstruction and those who did not.

Similarly, nine of 16 studies on body image showed no clear differences - including each of the three studies the researchers deemed to be "higher-quality."

And of 12 studies that looked at sexual functioning, seven found no differences, while the rest were split; in two, women who had undergone reconstruction reported poorer sexual functioning than those who had not opted for the procedure.

Researchers led by Dr. Clara Lee, of the University of North Carolina Chapel Hill, report the findings in the Journal of American College of Surgery.

The results point to average differences between women who chose to have or not have breast reconstruction, and they do not necessarily predict how any one woman will fare. Many factors, Lee's team writes, can affect a woman's satisfaction with reconstruction.

The researchers also point out that women who choose breast reconstruction may differ from those who do not in terms of quality of life, body image, and sexuality, which could affect how they perceived and reported the effects of reconstruction.

Finally, none of the studies looked at the "appropriateness" of patients' decisions to have breast reconstruction. Some women, for example, might have undergone reconstruction even if they were not convinced they truly wanted it - something that could affect their long-term satisfaction with the choice.

SOURCE: Journal of the American College of Surgery, July 2009.