ABSTRACTBackground Breast cancer remains the most prevalent malignancy among women globally. As survival rates improve, the clinical focus has shifted toward the quality of life (QoL) and psychosexual survivorship. This systematic review evaluates the impact of breast reconstruction (BR) on sexual function and body image in breast cancer survivors compared to mastectomy alone. Methods A systematic literature search was conducted in PubMed following PRISMA guidelines (January 2016-January 2026). Methodological quality was assessed using a mixed-methods approach: the Newcastle-Ottawa Scale (NOS) for observational studies, the Cochrane Risk of Bias (RoB 2) tool for randomized trials, and the CASP checklist for qualitative research. Results A total of 27 studies involving over 25,000 breast cancer survivors met the inclusion criteria. The findings indicate that women undergoing BR generally report significantly higher sexual function and body image scores compared to those undergoing mastectomy alone. Autologous reconstruction demonstrated superior long-term satisfaction and sexual well-being compared to implant-based techniques. Furthermore, breast-conserving therapy (BCT) was associated with better nipple sensation preservation compared to total mastectomy. Psychosexual outcomes were also influenced by age, body mass index (BMI), and relationship satisfaction. Notably, preoperative counseling was often reported as insufficient regarding sexual health. Conclusion Breast reconstruction is a vital component of holistic recovery, mitigating the negative psychosexual sequelae of mastectomy. Holistic oncological care must integrate sexual health assessments. Healthcare providers, including midwives and nurses, play a pivotal role in bridging the communication gap through preoperative counseling and postoperative support.
Triantafyllou et al. (Mon,) studied this question.