Breast reconstruction after mastectomy: does it decrease depression at the long-term?

With a life-time risk of 12–13%, breast cancer is the most prevalent malignancy among Dutch women (1). Although mastectomy without breast reconstruction (M) is a very effective and often curative procedure, it has a profound mutilating effect that inevitably influences a patient psychologically, often causing not only negative body image and anxiety, but also depression (2,3), a condition that is associated with breast cancer survivors in 22% (range, 17–48%) according to the Beck Depression Inventory (BDI) (4). This high prevalence emphasizes the interest of research in this population. A recent study by Vodermaier et al. showed that depression is strongly associated with mortality in younger patients with early stage breast cancer (5). This is in agreement with Watson and colleagues (6), revealing that women with a high score on the Hospital Anxiety and Depression (HAD) scale category of depression had a significantly increased risk of death from all causes within 5 years (hazard ratio: 3.59; 95% CI: 1.39–9.24). Another study found a hazard ratio for all-cause mortality in breast cancer patients of 1.27 (95% CI: 0.58–2.79) (7)