Clarifying the Expectations of Patients Undergoing Implant Breast Reconstruction: A Qualitative Study

Abstract

Background Unfulfilled expectations can lead to patient dissatisfaction with surgical outcomes. Understanding expectations allows surgeons to identify those patients who hold inaccurate expectations preoperatively, and to reset those expectations through focused pre-operative education. The purpose of this study is to investigate preoperative expectations of women undergoing implant breast reconstruction. Identifying inaccurate or unfulfilled expectations is a critical step towards the advancement of preoperative education and subsequently improving patient satisfaction with surgical outcomes. Methods In-depth, open-ended interviews were conducted with 28 women undergoing implant breast reconstruction. The interviews were recorded, transcribed, and data were coded using standard qualitative techniques. Results Interviews ascertained that implant-based breast reconstruction patients may have inaccurate expectations regarding the results of their surgery despite having received standard preoperative teaching. Specifically, patients often had unclear expectations regarding the appearance and physical outcome of the reconstructed breast(s). Some patients were surprised by the “flatness” of the tissue expander immediately following its insertion. Most patients felt unprepared for the “unnatural” final appearance of the breast(s). Furthermore, they did not expect many of the physical outcomes, including loss of sensation, firmness of the reconstructed breast(s), and lack of movement of the reconstructed breast(s). Inaccurate expectations corresponded to areas of dissatisfaction highlighted by the patients in postoperative interviews. Conclusion This study has important implications for preoperative education of women undergoing implant breast reconstruction. Physicians and nurses involved in the preoperative preparation process should take care to explore patients’ expectations regarding the look, feel, sensation, and movement of reconstructed breasts to increase overall postoperative satisfaction.

The Surprise of a Breast Reconstruction: A Longitudinal Phenomenological Study to Women’s Expectations About Reconstructive Surgery

“…Nevertheless, many interviewed women expect to still look scarred and deviant after reconstruction. Even more, in line with the very few health science studies that address other bodily expectations than only gazed ones (see Snell et al 2010), our results show that women's expectations often implicate the whole range of their bodily existence. These women have expectations about the practicality, capability, and feeling of their reconstructed breast(s) and body.…”

“…As such, appearance is not the only aspect of women's embodied existence we need to address within the process of reconstruction. Building on Snell et al (2010) recommendation, preoperative consultation may be improved by providing women with information about what they may or may not expect regarding their capable, practical, and felt body, along with information regarding their gazed body.…”

“…These studies mainly discuss whether women's expectations can be said to be realistic or not (Denford et al 2011;Holtzmann and Timm 2005;Snell et al 2010;Spector et al 2010). Realistic expectations are generally understood as ''anticipating an event or outcome [that] is likely to occur'' (Wiles et al 2008: 565) and they are associated with the patient's satisfaction about the end result (Iversen et al 1998).…”

“…Realistic expectations are generally understood as ''anticipating an event or outcome [that] is likely to occur'' (Wiles et al 2008: 565) and they are associated with the patient's satisfaction about the end result (Iversen et al 1998). In the case of having unrealistic expectations, then, this literature often debates the issue how women-patients can be facilitated by medical professionals in formulating (more) realistic expectations (Denford et al 2011;Snell et al 2010;Spector et al 2010).…”

“…Moreover, various authors formulate the insight that expectations, their intensity and nature, may vary over time, in relation to other life events (Bury 1997;Wiles et al 2008), and with regard to various aspects of embodiment such as appearance or sensitivity (Snell et al 2010). Further, the rich tradition of sociology of expectations shows that expectations-its formulations and development-are socially mediated (Lindemann 2005;Luhmann 2014) and that expectations-rather than being explicitly articulated-may also be implicit and tacit (Garfinkel 1984).…”