The Impact of Delaying Breast Reconstruction on Patient Expectations and Health-Related Quality of Life: An Analysis Using the BREAST-Q

Abstract

Purpose: An understanding of patient expectations predicts better health outcomes following breast reconstruction. No study to date has examined how patient expectations for breast reconstruction and preoperative health-related quality of life vary with time since breast cancer diagnosis. Methods: Women consulting for breast reconstruction to a single surgeon’s practice over a 13-month period were enrolled in this cross-sectional study. Patients were asked to prospectively complete the BREAST-Q expectations and preoperative reconstruction modules. A retrospective chart review was then performed on eligible patients, and patient demographics, cancer-related factors, and comorbidities were collected. BREAST-Q scores were transformed using the equivalent Rasch method. Multivariate linear regression models were constructed to assess the association between BREAST-Q scores and time since cancer diagnosis. Results: Sixty-five patients met inclusion criteria for analysis and are characterized by a mean age of 53 ± 11 (34-79) years and a mean body mass index of 28 ± 6 (19-49). Most patients were treated by mastectomy (58%) or lumpectomy (23%). At the time of retrospective chart review, 29 (43%) patients had undergone reconstruction, most of which were delayed (59%). The mean latency from cancer diagnosis to reconstruction was 685 ± 867 days (range: 28-3322 days). Latency from cancer diagnosis to reconstruction was associated with a greater expectation of pain (β = 0.5; standard error [SE] = 0.005; 95% confidence interval [CI]: 0.003-0.027; P < .05), and a slower expectation for recovery (β = −0.5; SE = 0.004; 95% CI: −0.021 to −0.001; P < .05) after breast reconstruction. Latency from cancer diagnosis to reconstruction was associated with an increase in preoperative psychosocial well-being (β = 0.578; SE 0.009; 95% CI: 0.002-0.046; P < .05). Conclusion: Delaying breast reconstruction may negatively impact patient expectations of postoperative pain and recovery. Educational interventions aimed at understanding and managing patient expectations in the preoperative period may improve health-related quality of life and patient-related outcomes following initial breast cancer surgery.

Autologous Fat Grafting as a Stand-alone Method for Immediate Breast Reconstruction After Radical Mastectomy in a Series of 15 Patients

“…42 This approach allows us to perform the breast reconstruction immediately after mastectomy, and it has been shown that delaying reconstruction negatively impacts the patient's expectations. 44,45 We do note some limitations of our study. Although our cosmetic results were very satisfactory with few minor complications, our study lacked the use of a validated patient-reported outcome tool to study the patients' overall experience of the procedure.…”

Translation and cross-cultural adaptation of the Brazilian version of BREAST-Q©: breast reconstruction expectations module

“…To increase the benefits for patients and guide the decision-making process for treatment, accurate and relevant information must be provided preoperatively in a clear, objective, and efficient manner 10,16,17 . When the information received is insufficient, it can lead to imprecise expectations, culminating in disappointment with the surgical result and the postoperative recovery 5,8 .…”

“…Identifying patients' expectations when making a decision regarding surgical treatment can potentially improve the informed consent process and prepare them for their postoperative recovery and also for the possibility of complications and the need for other treatments 10 . Furthermore, exploring expectations individually can allow surgeons to recognize patients who have unrealistic expectations, in order to address misunderstandings in the preoperative moment, through better education.…”

“…Patients have expectations regarding the effectiveness of their treatment and postoperative recovery, which are built from information received in the preoperative period [7][8][9] . Therefore, exploring patients' expectations is important to establish actions in order to avoid misconceptions regarding treatment and to improve satisfaction with the surgical care 10,11 .…”

Optimizing the Pedicled Latissimus Dorsi Myocutaneous Flap in Breast Reconstruction: Lessons Learned from 110 Consecutive Flaps

“…2 Breast reconstruction following these procedures has been shown to improve patients' mental health, sexual health, and overall satisfaction. 2 There are several surgical options for complete or partial breast reconstruction. The pedicled latissimus dorsi myocutaneous flap (LDMCF) is a versatile technique that can be used for delayed or immediate breast reconstruction, with prosthesis in the form of tissue expanders (TEs) or direct-to-implant (DTI), or alone as an autologous flap.…”