Does Breast Reconstruction Impact the Decision of Patients to Pursue Cosmetic Surgery?

Background:  Breast reconstruction is an integral component of breast cancer treatment, often aiding in the restoration of a patient’s sense of femininity.  However, some women remain concerned with their body image after reconstruction.  Many patients choose to have subsequent cosmetic surgery, such as body contouring and facial rejuvenation procedures.

The purpose of this study is to investigate the factors that motivate patients to have cosmetic surgery following breast reconstruction, and identify factors associated with improvements in self-image. 

Methods:  The authors performed a retrospective study examining patients who had breast reconstruction and subsequent cosmetic surgery in the University of Pennsylvania Health System between January 2005 and June 2012.  All autologous and implant reconstructions were included. This cohort received a questionnaire developed to assess the influences and impact of reconstructive and cosmetic procedures.

Results:  A total of 1,214 patients underwent breast reconstruction during the study period, with one hundred thirteen (9.3%) recieving cosmetic surgery following reconstruction. Fourty-two patients responded to the survey (37.1%); of these, 35 had autologous breast reconstruction (83.3%).

Fifty two cosmetic procedures were performed in survey respondents, including liposuction (33.3%), facelift (19.0%) and blepheroplasty (11.9%).  The most common reason for undergoing cosmetic surgery was the desire to improve self-image (n=26, 61.9%), with 29 (69.0%) patients feeling more self-conscious of appearance following reconstruction. While body-image satisfaction was significantly higher following cosmetic surgery (p=0.0081), twelve patients (28.6%) experienced no improvement in body image at all. Interestingly, a multivariate analysis revealed that patients who experienced an improvement in body-image following breast reconstruction were more likely to experience a further improvement following a cosmetic procedure (p=0.031, OR 17.83).  Furthermore, patients who were interested in cosmetic surgery prior to reconstruction were more likely to experience an improvement in body image following a cosmetic procedure (p=0.012, 22.63).

Conclusions:  The decision of breast reconstruction patients to undergo cosmetic surgery appears to be influenced mostly by a desire to improve self-image. Cosmetic surgery after breast reconstruction may improve body image satisfaction of patients and help to further meet their needs and expectations. Improvements in body image following cosmetic surgery however, are more likely to occur in patients who: (1) experienced an improvement in body image following breast reconstruction, and (2) were interested in cosmetic surgery prior to reconstruction.