Psychological factors, especially related to body image, may affect the risk of complications after breast reconstruction surgery, reports a study in the March issue of Plastic and Reconstructive Surgerythe official medical journal of the American Society of Plastic Surgeons (ASPS).

“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 in Atlanta, and colleagues. The researchers suggest 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.

Preoperative Body Image Concerns May Predict Breast Reconstruction Outcomes

To assess the possible impact of body image and other psychological factors, the researchers analyzed 302 women undergoing post-mastectomy breast reconstruction from 2011 to 2015. Before surgery, the women completed the validated BREAST-Q questionnaire, which includes 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. 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 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. 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.

“Identifying aspects of the BREAST-Q that predict poor outcomes may allow surgeons to refer at-risk patients for further psychological assessment,” Losken and coauthors write. The findings suggest that items related to body image, self-confidence, and attractiveness can have a significant impact on important complications after breast reconstruction surgery.

The findings raise the possibility that identifying and addressing these psychological factors before surgery might help to reduce the risk of complications after breast reconstruction. Losken and colleagues draw a comparison with other types of efforts to reduce patient-related risk factors—for example, smoking cessation, weight loss, or “prehabilitation” 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, 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.”