Published online Aug 19, 2026. doi: 10.5498/wjp.118378
Revised: February 26, 2026
Accepted: March 27, 2026
Published online: August 19, 2026
Processing time: 176 Days and 23 Hours
Breast cancer is the most frequently diagnosed malignancy in females globally, and total mastectomy commonly initiates substantial anxiety and depression symptomatology. Although previous studies have mainly evaluated breast reconstruction as a psychological intervention that achieves superior psychosocial outcomes, relatively limited research has investigated postoperative psychological distress as an influential factor in shaping patients’ cognition, attitudes and acceptance of reconstruction after mastectomy (especially from the perspective of Chinese patients, where a low rate of radical mastectomy being followed by immediate or delayed breast recon.
To investigate the prevalence of postoperative anxiety and depression symptoms in breast cancer patients and explore its associations with willingness, cognition, and attitudes toward breast reconstruction to provide evidence for improving mental health and quality of life.
A total of 112 breast cancer patients receiving surgical management in Tianjin Medical University Cancer Institute and Hospital between October 2023 to October 2024 were enrolled in this retrospective study. The study utilized the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) to measure anxiety and depression symptoms. Concurrently, patients Search of demand knowledge and comprehension based on breast re
Among 112 patients, the prevalence of anxiety symptoms was 42.86% (48/112), depression symptoms 39.29% (44/112), and anxiety-depression comorbidity 28.57% (32/112). The SAS score was 46.25 ± 10.82, and the SDS score was 48.73 ± 11.35. The cognition score for breast reconstruction was 18.73 ± 4.72, the attitude score was 44.82 ± 8.83, and the reconstruction intention rate was 32.14%. Correlation analysis showed that the SAS score was negatively correlated with the cognition score (r = -0.412, P < 0.01) and attitude score (r = -0.386, P < 0.01); the SDS score was negatively correlated with cognition score (r = -0.435, P < 0.01) and attitude score (r = -0.402, P < 0.01). Multiple regression analysis showed that anxiety-depression scores were independent negative influencing factors for cognition and attitude (P < 0.05). Logistic regression showed that anxiety score [odds ratio (OR) = 0.876, 95% confidence interval (CI): 0.812-0.945], cognition score (OR = 1.193, 95%CI: 1.040-1.461), and attitude score (OR = 1.340, 95%CI: 1.098-1.792) were independent predictors for reconstruction intention.
The prevalence of anxiety and depression symptoms in breast cancer patients after total mastectomy is high. Anxiety and depression symptoms are significantly associated with lower cognition levels and more negative attitudes, and demand for breast reconstruction. The more severe the anxiety and depression, the lower the cognition, the more negative the attitude, and the lower the willingness for reconstruction. Clinical practice should emphasize the assessment and intervention of mental health in breast cancer patients. Improving anxiety and depression symptoms may help enhance patients’ cognition and acceptance of breast reconstruction, ultimately improving quality of life.
Core Tip: Postoperative anxiety and depression are highly prevalent among breast cancer patients after total mastectomy and are strongly associated with reduced willingness for breast reconstruction. This study demonstrates that anxiety and depression negatively affect patients’ cognition and attitudes toward breast reconstruction, which in turn diminishes reconstruction intention. Patients with anxiety-depression comorbidity show the most pronounced decline. These findings highlight mental health as a modifiable factor in reconstruction decision-making and underscore the importance of integrating psychological assessment and intervention into routine breast cancer care to improve reconstruction acceptance and overall quality of life.