A pre-consultation educational group intervention improves patients' shared decision-making quality compared to routine preoperative patient education. A full-scale definitive RCT is warranted based on high feasibility outcomes, and the primary outcome for the main trial will be decisional conflict.

Review CMAJ• Breast reconstruction after mastectomy is an oncologically safe procedure that can improve psychosocial outcomes.• Increased age, nonwhite ethnic background, low income and nonurban residence are associated with decreased rates of breast reconstruction.• Physician perceptions and knowledge, as well as cancer stage, also influence the rate of this procedure.• Mastectomy with immediate breast reconstruction should be presented to patients with in situ or early stage breast cancer as an option along with breast-conservation therapy and mastectomy alone.

IBR is available to select patients with favorable clinical and demographic characteristics who travel farther to undergo surgery at teaching hospitals with two or more available plastic surgeons.

Geographic access to a plastic surgeon is a major determinant of BR. Targeted interventions for regions without high access to plastic surgeons may improve overall rates and reduce geographic disparities in care, particularly for IBR.