How Informed Is the Decision About Breast Reconstruction After Mastectomy?

Abstract

Objective to assess how informed patients are about breast reconstruction, and how involved they are in decision making. Summary Background Data Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making. Methods We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model. Results 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%). Conclusions Women undergoing mastectomy in this sample were highly involved in decision making but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers appeared to have discussed the advantages of reconstruction more than its disadvantages.

Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities

“…Patients equated trauma from hearing they had breast cancer with PTSD and feared that just going for mammograms would trigger similar anguish. Consistent with research showing that misinformation influences women's choices, participants had limited knowledge about the harms of CPM when making their decision …”

“…It follows that they may be willing to accept substantial trade‐offs if they believe that CPM will give them longer, healthier lives . Other studies cite the role of additional factors including their surgeon's mindset, a desire for symmetry, new options for reconstruction; overestimating their risk for contralateral breast cancer (CBC), cancer‐related worry, and limited knowledge about the benefits and harms of CPM, especially the likelihood of complications …”

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