Breast reconstruction and psychosocial adjustment: what have we learned and where do we go from here?

For women with breast cancer, there are many treatment options, with surgery often the primary treatment for early-stage disease. An increasing number of women are choosing to have reconstruction following their mastectomies. Both surgical and medical treatments for breast cancer are increasingly evaluated not only on the basis of their safety and medical outcomes but also their impact on women's psychosocial and quality of life (QOL). The objective of this article is to describe current knowledge regarding the psychosocial adjustment of women undergoing reconstruction, identify limitations in the existing literature, and offer suggestions for the direction of future work in this area. Though most studies have found comparable general QOL in women who have different surgical treatments for breast cancer, some research suggests that reconstruction may provide benefits in terms of body image and sexuality, especially compared with women who have mastectomies only. Most of the existing studies have failed to consider the potential importance of demographic- and treatment-related variables on women's psychosocial adjustment. As reconstruction procedures continue to be developed and refined, the impact of these procedures on women's short- and long-term psychosocial adjustment and QOL is needed.