The AAPS 103rd Annual Meeting 2025

Patient and Injury-related Predictors of Digit Replantation Failure: Implications of Preoperative Nicotine Dependence

Introduction

Breast cancer is associated with significant psychological morbidity which negatively impacts quality of life 1
New-onset depression or anxiety increases the risk of breast cancer recurrence and cancer-specific mortality 2
Breast reconstruction restores body image and improves psychological well-being, but the impact of the reconstructive modality is unclear 3
We investigated the impact of autologous versus implant-based reconstruction on post-mastectomy depression rates .

Methods

Data Source: TriNetX federated database of electronic medical records
Population: Adult women with breast cancer who underwent mastectomy followed by either autologous (pedicled or free tissue transfer) or implant-based reconstruction
Exclusions: Patients who underwent multiple reconstruction modalities
Variables Assessed: Patient clinicodemographic data, psychosocial history and tumor characteristics
Primary Outcome: Depression rates at 3 years after diagnosis
Analysis: Relative risks (RR) reported. Propensity score-matched 1:1 for age, race, BMI, nodal and metastasis status

Results and Discussion

After controlling for pre-operative depression, implant-based reconstruction was found to be associated with more severe depressive symptoms and major depressive disorder
Pre-existing depression is an important confounding variable to consider, which may explain the variation in literature findings
Immediate breast reconstruction is protective against depression

Limitations:
Autologous group includes pedicled TRAM and latissimus dorsi flaps, limiting generalizability to DIEP flap population
Anxiety symptoms are also prevalent and further evaluation into these measures of psychological well-being is needed

Conclusions

Autologous reconstruction results in greater rates of depression, but a lower risk of severe symptoms and diagnosis of major depressive disorder
Pre-existing depression is an important confounding variable
Our findings support immediate breast reconstruction when feasible for improved psychological outcomes
Further research into free-flap reconstruction-specific outcomes is needed

Psychological Outcomes After Mastectomy: Implant Vs. Autologous Reconstruction