D17. When Is Enough Enough? Reconstructive Revision Rates and Emotional Well-Being

PURPOSE: Up to 30-40% of patients will undergo elective revision procedures following breast reconstruction. This study aims to assess the relationship between pre-operative emotional-well-being and number of revision breast reconstruction procedures in implant-based reconstruction (IBR). METHODS: A retrospective review was performed of patients who underwent IBR by a single surgeon between 2012-2017 with a minimum follow-up period of 5 years. Medical records and medications were reviewed for a history of generalized anxiety disorder (GAD) and/or major depressive disorder (MDD). Revision procedures were defined as additional elective operations that fall outside of the index reconstructive algorithm. RESULTS: A total of 272 patients met inclusion criteria. The total rate of revision surgery was 16.5%. Thirty-seven (13.6%) patients underwent a single revision procedure, and 8 (2.9%) underwent more than one revision procedure. The revision rate of patients with a history of mental health disorder was 24.8% compared to 10.7% in patients without (p<.005). Revision rates of patients with MDD were 37.5%, compared to 5.0% in patients with GAD, and 21.8% in patients diagnosed with both (p<0.005). On logistic regression analysis, the presence of a psychiatric diagnosis was associated with 2.75 times higher odds of revision surgery (OR 2.75 CI 1.42-5.32, p=.003). CONCLUSION: Peri-operative emotional well-being impacts the rate of secondary revision surgery in patients who undergo IBR. While a prior mental health diagnosis should not deter patients from implant-based reconstruction, it is important to optimize emotional well-being by encouraging patients to seek care for concurrent mental health diagnoses.