Survey of Psychosocial Problems Facing Breast Cancer Survivors after Undergoing a Mastectomy and Their Awareness of Breast Reconstruction

Abstract

Purpose: Breast reconstruction in patients who have undergone a mastectomy is performed less frequently in Korea than in Western countries. The aim of this study was to investigate the psychosocial problems related to a mastectomy and awareness of reconstruction after a mastectomy in breast cancer survivors. Methods: From March to April 2010, 252 patients who underwent a mastectomy were recruited for this survey. The questionnaire included sociodemographic characteristics of patients, psychosocial problems related to mastectomy, and reasons not to receive breast reconstruction. Results: Patients had difficulty going to a public bath (70.3%) or going to a swimming pool or the beach (74.6%). More than half of patients answered that their physical activity had decreased due to persistent shoulder or arm pain after the mastectomy. The most common psychological problem that patients experienced was distress over the loss of charm as a woman (66.8%), followed by considering themselves disabled (62.0%), and worries about recurrence (59.4 %). The most common reason not to receive a breast reconstruction was the high cost of the operation (59.4%), followed by anxiety about complications (46.7%). Only 16.2% of patients reported that they did not receive enough information about reconstruction from their doctor. Of 229 patients, 43.7% would consider undergoing breast reconstruction in the future. Conclusion: Breast cancer survivors who underwent a mastectomy suffered from various psychosocial problems, and high cost was a major reason for not undergoing breast reconstruction. Broader health insurance coverage should be provided for breast reconstruction in breast cancer survivors.

A Decision Tree Model for Breast Reconstruction of Women with Breast Cancer: A Mixed Method Approach

“…The study identified the recovery of body image as the most important factor in decision to have BR for WBC. This is consistent with numerous previous findings [ 5 , 20 , 21 , 30 ]. This is also related to the findings that fear of losing femininity due to mastectomy affected the decisions to have BR [ 17 , 31 , 32 ].…”

“…The study results also showed that BR decisions were affected by the patient’s financial resources, consistent with many findings that household income or having private insurance affects the rate of BR [ 20 , 37 , 38 , 39 ]. However, as the number of health care beneficiaries increase, such as in Korea, the decision-making criteria for BR must be reviewed for any changes.…”

“…Previous studies found that the size of surgery, length of recovery, and risks of complications were important in deciding for BR and the main reason for not undergoing BR was the fear of complications [ 17 , 20 ]. Unlike previous studies, however, concerns about BR surgery or its complications were not identified as major criteria for decision-making in this study.…”

“…Semi-structured interview with open-ended questions was utilized to encourage the participants to recall and explain specific examples of decision-making and to maximize participants’ point of view. In the preliminary stage, previous studies on BR experiences were analyzed to identify the factors influencing BR decisions and interview questions were drawn [ 10 , 15 , 17 , 20 , 21 ]. As the interview progressed, we continued to ask more specific questions based on the participants’ interviews.…”

“…Since no differences are reported in local recurrence rates and treatment outcomes across types of reconstruction [ 8 ], greater consideration is required in selecting reconstruction type. In addition to these medical factors, other situations and conditions, such as psychological, social, and economic conditions need to be considered in decision-making [ 20 , 21 ]. Thus, more comprehensive understanding about meanings and perspectives about BR among WBC is needed to help them reach evidence-informed and value-congruent decisions about BR.…”