Women’s Psychosocial Outcomes following Breast Cancer Surgery and Breast Reconstruction and the Associated Interventions

  • Hannah Matthews

Student thesis: Doctoral ThesisDoctor of Philosophy


Objective: The number of women undergoing mastectomy and the number of women electing for breast reconstruction is increasing. This research is both necessary and timely in order to identify and understand more comprehensively the unmet needs of women following breast reconstruction and breast cancer surgery.

Design: This research is comprised of three inter-related studies: a quantitative questionnaire-based study, a qualitative interview-based study and a systematic review and meta-analysis.

Methods: For study 1, a retrospective cross-sectional study, 148 women who elected for post-mastectomy breast reconstruction completed a questionnaire. Data were analysed using hierarchical multiple regression analyses. For study 2, a qualitative retrospective study, in-depth semi-structured interviews were conducted with 25 women following reconstruction. Data were analysed using template analysis. For study 3, the review, a comprehensive literature search was undertaken using keyword and subject headings within 7 databases. Included studies employed a quantitative methodology and presented empirical findings which focused on interventions for women following breast cancer surgery.

Findings: Study 1 demonstrated psychosocial factors were able to predict a high percentage of the total variance for breast satisfaction (75%) and outcome satisfaction (68%), and a modest percentage for quality of life (46%) following post-mastectomy breast reconstruction. Study 2 established most women were satisfied with their breast appearance and overall reconstructive outcome, and many experienced positive emotional gains and a renewed appreciation for life. However, these gains were often accompanied with substantial deterioration in physical, sexual and social functioning. Study 3 demonstrated that cognitive behavioural therapy based interventions often have ameliorative effects on depression, anxiety and quality of life.

Conclusion: The thesis provides novel findings in relation to post-mastectomy breast reconstruction through the incorporation of psychological, social, clinical and demographic variables. This thesis also defines and distinguishes distinct dimensions of satisfaction and quality of life, as these measures are often conceptually confused and a clear multidimensional definition is rarely applied across research. This thesis also applies template analysis to explore the experiences of women following breast reconstruction. This is a novel application of the qualitative data analysis method, which demonstrates only slight variation in some categories of experience among women. The thesis also identifies outcomes of clinical importance and is the first meta-analysis to evaluate the efficacy of interventions to improve psychosocial outcomes following breast cancer surgery.

Clinical Implications: The findings of this thesis provide a more in-depth understanding of the unmet needs of women following breast reconstruction and could be used to inform women of the likely outcomes of different reconstructive procedures. The findings may also allow clinicians and patients to identify specific areas of focus which may require further surgical or psychological intervention, in order to enhance both satisfaction and quality of life following reconstruction. The thesis recommends the implementation of specialist breast reconstruction nurses, trained in cognitive behavioural therapy to provide educational and psychosocial support throughout the reconstructive process.

Future Research: Future research should consider the experience of post-mastectomy breast reconstruction from a prospective, longitudinal stance. Researchers should also consider the benefit of evaluating objective experience alongside subjective outcomes measures to provide a more meaningful understanding of experience.
Date of AwardApr 2018
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorAndy Turner (Supervisor), Iain Williamson (Supervisor) & Wendy Clyne (Supervisor)

Cite this