Reconstructive breast surgery aims to improve body image following mastectomy, yet many women experience ongoing body image distress (BID). The relationship between the esthetic outcome of reconstructive surgery with BID has been underexplored in mastectomy. This study aimed to assess whether reconstruction outcome following mastectomy is associated with post-surgery BID, and to examine potential psychological risk and maintenance factors for BID above reconstruction outcome. In 49 women undergoing mastectomy with immediate breast reconstruction, we prospectively assessed hypothesized pre-surgery psychological risk factors and post-surgery maintenance factors for post-surgery BID. Reconstruction outcome was assessed via blind surgeon ratings of post-surgery photographs. Surgeon-rated reconstruction outcome was uncorrelated with BID, or with patients’ ratings of surgical outcome. Higher pre-surgery depressive symptoms and lower pre-surgery patient expectations for reconstruction predicted greater post-surgery BID, above reconstruction outcome. Post-surgery body checking also predicted greater BID, above reconstruction outcome. Results suggest that the medical team cannot assume their perception of reconstruction outcome matches the patient’s view or degree of BID. If replicated, results point to potential psychological risk and maintenance factors that are stronger predictors of post-reconstruction BID, highlighting opportunities for light-touch prevention and intervention to reduce BID after mastectomy with breast reconstruction.

乳房重建手术旨在改善乳房切除术后的身体形象，但许多女性会经历持续的身体形象困扰 (BID)。在乳房切除术中，重建手术的美学效果与 BID 之间的关系尚未得到充分探讨。本研究旨在评估乳房切除术后的重建结果是否与术后 BID 相关，并检查 BID 高于重建结果的潜在心理风险和维持因素。在 49 名接受乳房切除术并立即进行乳房重建的女性中，我们前瞻性地评估了假设的术前心理危险因素和术后 BID 的术后维持因素。通过外科医生对术后照片的盲评来评估重建结果。外科医生评定的重建结果与 BID 或患者对手术结果的评定不相关。较高的术前抑郁症状和较低的术前患者对重建的期望预示着较高的术后 BID，高于重建结果。术后身体检查还预测 BID 会高于重建结果。结果表明，医疗团队不能假设他们对重建结果的看法与患者的观点或 BID 程度相符。如果重复的话，结果表明潜在的心理风险和维持因素是重建后 BID 的更强预测因素，强调了轻触预防和干预的机会，以减少乳房切除术和乳房重建后的 BID。