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Updated: Jun 18, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Somatoform Disorders Affect Decision-making of Breast Reconstruction Post-Mastectomy of Breast Cancer Patients: A
Shih-Jung Lin1, Nhu Quynh Phan2,3, Jin-Hua Chen4,5,6
1School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Background:
Somatoform disorders (SDs), including somatic symptom disorder and body dysmorphic disorder, are increasingly recognized for their impact on surgical decision-making. Their influence on breast reconstruction (BR) timing and type following mastectomy remains underexplored.
Methods:
Using the TriNetX National Health Research Network, we conducted a retrospective cohort study of 192,618 breast cancer patients who underwent mastectomy between 2005 and 2023. Patients were stratified into cohorts based on the presence or absence of a documented SD diagnosis (ICD-10: F45). Propensity score matching was applied to balance baseline characteristics. Primary outcomes included BR timing (immediate and delayed) and method (autologous and implant-based).
Results:
Among the cohort, 3067 (1.6%) had an SD diagnosis. Immediate BR rates were not significantly different between groups. However, patients with SDs were significantly more likely to undergo delayed BR: HR = 1.59 (95% CI 1.21-2.09) for autologous and HR = 1.24 (95% CI 1.06-1.45) for implant-based reconstruction. Overall BR rates within two years were modestly higher in the SD group.
Conclusions:
While SDs do not deter patients from choosing immediate BR, they are associated with delayed reconstruction, likely reflecting psychological factors, such as decisional conflict, risk sensitivity, and body image concerns. Integrating mental health assessment into preoperative counseling may facilitate more timely and individualized BR decisions. Further research should examine long-term satisfaction and outcomes in this population.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
