Psychological Outcomes After Mastectomy With vs Without Nipple-Areolar Complex Reconstruction: A Propensity-Matched...

Breast reconstruction after mastectomy restores both physical and emotional well-being. Nipple-areolar complex (NAC) reconstruction represents the final stage of restoration, yet its psychological impact remains unclear.

This study evaluates mental health outcomes following NAC vs non-NAC breast reconstruction.

The TriNetX Research Network was queried for female breast cancer patients ≥ 18 years who underwent mastectomy with subsequent breast reconstruction from 2003 to 2023. Cohorts were stratified by NAC reconstruction. Propensity score matching was performed for demographics, comorbidities, substance use, cancer treatment, and pre-existing psychiatric conditions. Outcomes included various psychological conditions such as anxiety, depression, and antidepressant use at 3-, 12-, and 24-months postoperatively. Risk ratios (RRs), 95% CIs, and P values were calculated.

Nipple-areolar complex reconstruction was associated with significantly lower risks of several psychiatric outcomes. Anxiety was reduced at 3 months (RR = 0.40; P = .0004), 12 months (RR = 0.62; P = .0009), and 24 months (RR = 0.79; P = .026). Adjustment disorder was less frequent at 12 (RR = 0.52; P = .0099) and 24 months (RR = 0.65; P = .024). Substance use disorder (RR = 0.40; P < .0001) and antidepressant use (RR = 0.82; P = .034) were also significantly reduced at 24 months.

Nipple-areolar complex reconstruction is linked to lower long-term risks of various psychological conditions following mastectomy, suggesting psychosocial benefits beyond aesthetic restoration. These findings support holistic consideration of both surgical and mental health factors in reconstructive counseling.