Determinants of Patients? Choice of Reconstruction with Mastectomy for Primary Breast Cancer

Abstract

In a context of maximum autonomy, the great majority of the women chose IBR. The patients' choices were explained mainly by their psychosocial characteristics. The indication for BR should be properly discussed between patients and surgeons before mastectomy.

Younger women’s experiences of deciding against delayed breast reconstruction post-mastectomy following breast cancer: An interpretative phenomenological analysis

“…Although UK reconstruction rates by age are presently unclear, the women in this study perceived themselves to be going against a norm. This might possibly be due to their younger age at diagnosis.Surgeons are suggested to deliver proreconstruction information to younger breast cancer patients (Alderman et al, 2008), and this group are more likely to choose this surgical option (Reaby, 1998;Rowland et al, 2000;Ananian et al, 2004;Finlayson et al, 2001, Jagsi et al, 2014. It is suggested by some of our participants that their medical teams assumed that they, as younger women, would prefer reconstruction even as a delayed option.…”

“…Factors other than age also influence surgical decisions post-mastectomy such as country, region, cancer centre and race/ethnicity (Morrow et al, 2001;Rubin et al, 2013) with input of surgeons also having an effect (Noone et al, 1982;Ananian et al, 2004).…”

“…The medical literature commonly suggests that offering women a reconstruction is surgically optimal (Fang, Shu and Chang 2013;Crompvoets, 2006), especially for younger women (Roje et al, 2010) with studies reporting the psychosocial benefits of reconstruction (Wilkins et al, 2000;Ananian et al, 2004), particularly in terms of immediate versus delayed procedures (Al Ghazal et al, 2000). The picture becomes increasingly complex when pre-existing characteristics such as mental health and body image are considered (Rubino et al, 2007;Krauss, 1999;Figuerido et al, 2004).…”

Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?

“…Perceived importance of body image, a lack of fear regarding surgery and the ability to discuss surgical choices with a partner were associated with a greater likelihood of reconstruction. 17 While these issues may play a role, it's important to recognize other possible etiologies of the age disparities that have been documented in the treatment of breast cancer. 33,[36][37][38] Documented variations in the patient-physician interaction based on age have been linked with differences in the likelihood that appropriate quality breast cancer care was received.…”

“…Studies suggest that patient perception of the surgeon's preference plays a major role in patient decision-making regarding breast surgery. 17,18 We also know that there are racial and ethnic variations in physician-patient communication and in patient perceptions of the quality of their communication with physicians. [19][20][21][22] Figure 1 illustrates how clinical factors, patient preference, provider bias in discussing reconstruction, and qualitative aspects of communication can contribute to whether or not a patient receives reconstruction.…”