Presidential Address: Our Patients' Future in a Changing World: The Imperative for Psychiatric Involvement in Public Policy

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Abstract
Patients who had reconstructive breast surgery at the time of mastectomy (immediate) or within 1 yr (early) had significantly less recalled distress about their mastectomy than those who had it > yr later (delayed). Women who had immediate or delayed reconstructive surgery had similar levels of psychological symptoms, which were slightly lower than those reported by women in the early reconstruction group. The wish to wear a wider range of clothes and the wish to be rid of the external prosthesis were common motivations for reconstructive surgery. The desire to improve sexual relations or one''s marital state was less common and should be viewed with caution when presented as the primary motivation for this procedure.