Satisfaction Outcomes in Women Who “Choose to Go Flat” After Mastectomy

Abstract

A considerable number of women undergoing mastectomies are “choosing to go flat,” forgoing reconstruction. This integrative review sought to identify satisfaction outcomes and relevant factors among these women. Using variations of the key word “going flat,” a systematic search of 7 databases was conducted. Fifteen articles met the inclusion criteria and were reviewed. Decisional and breast/chest appearance satisfaction in women who did not have reconstruction was mixed when compared with other surgical options. Body image, body mass index, radiation therapy, and access to information/resources affected satisfaction. Nurses are in a pivotal role to address the communication and informational needs of these women to support optimal surgical decision-making processes and improve patient satisfaction and clinical outcomes.

Women’s decision process when actively choosing to ‘go flat’ after breast cancer: a constructivist grounded theory study

“…This study highlights that fear of cancer is not the dominating driving force for women opting for flat closure and abstaining from reconstruction. Although fear is present in the process, there are other aspects that are more significant for the individual and this finding is in line with current research [3,[6][7][8]. Furthermore, being over 70 years at diagnosis, increasing comorbidities, radiotherapy and adjuvant chemotherapy have been found as significant factors associated with higher likelihood of opting flat closure [35].…”

“…Nevertheless, research concerning experiences of flat closure is limited. Women opting for a flat closure are often grouped together with all women who have not had a breast reconstruction, including women on the waiting list for a breast reconstruction and women who want a breast reconstruction but are not candidates for reconstructive surgery [7]. This mix of women makes the evidence base scarce and the patient-care giver dialogue complicated [7,8].…”

“…Women opting for a flat closure are often grouped together with all women who have not had a breast reconstruction, including women on the waiting list for a breast reconstruction and women who want a breast reconstruction but are not candidates for reconstructive surgery [7]. This mix of women makes the evidence base scarce and the patient-care giver dialogue complicated [7,8]. Some studies with a mixed population [8], have indicated that a bilateral mastectomy leads to an increase in post-operative complications [9] and a decrease in quality of life, as well as body-image [10].…”

“…Knowledge regarding why women actively choose a flat closure is scarce. Thus, more insight into their decisionmaking process and the resulting consequences is needed to ensure flat closure can be offered in the correct situations and for the right reasons [7], enabling it to become a fully-fledged alternative in the breast cancer treatment armamentarium. A fundamental prerequisite for shared decision making (SDM) is that patients have self-efficacy, meaning they believe in their own capacity [14].…”

Information needs in breast reconstruction after mastectomy: a qualitative analysis of free-text responses from 2077 women

“…Some women were confronted with a lack of acceptance and reluctance from surgeons to discuss aesthetic flat closure and felt pressured to have a reconstruction. Work from the US has found that women perceive a low level of surgeon support if they decide to go flat and this is often the strongest predictor for low satisfaction with surgical outcomes [ 43 , 44 ]. This study extends the literature by highlighting that some women have information needs around non-reconstruction options, which are often not supported by surgeons.…”