‘It's a silver lining’: A template analysis of satisfaction and quality of life following post‐mastectomy breast reconstruction

Abstract

This study provides new insights into post-mastectomy breast reconstruction and is a novel application of template analysis. The analysis demonstrates only slight variation in some categories of experience among women, despite a heterogeneous sample. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life to support the needs of women following reconstruction. Statement of contribution What is already known on this subject? Patient satisfaction and quality of life are key patient-reported outcomes of breast reconstruction, although relatively few studies distinguish between types of satisfaction. The number of women electing to undergo reconstructive surgery is steadily increasing. As a consequence, exploring patient-reported outcomes in reconstructive breast surgery has become increasingly important for research and clinical practice. It is often suggested that breast reconstruction offers psychosocial benefits, although within the literature some mixed findings have been reported. Therefore, a qualitative exploration has the potential to add some clarity to the experiences of women following post-mastectomy breast reconstruction. What does this study add? To our knowledge, this is the first study to employ template analysis to explore the experiences of women following post-mastectomy breast reconstruction. Template analysis demonstrated that there was only slight variation in some categories of experience among women, despite a heterogeneous sample. This study distinguishes between the patient-reported outcomes breast satisfaction and outcome satisfaction to identify the key factors that are involved in determining satisfaction. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life which require improvement to support the unmet needs of women following breast reconstruction. The study presents two novel findings. Women attributed the fear of cancer recurrence to no longer being able to have a mammogram on the affected breast(s). Women also reported a decline in appearance-related satisfaction over time due to either the ptotic nature of autologous-based reconstruction or the fuller projected breast implant-based reconstruction affords.

A systematic review of factors affecting quality of life after postmastectomy breast reconstruction in women with breast cancer

“…Santosa et al, found that psychosocial, physical, and sexual well‐being increased with time after this surgery. However, Matthews and colleagues did not find this variable to be a significant predictor of quality of life.…”

“…Two studies suggested that older patients reported higher levels of overall quality of life after breast reconstruction . The remaining studies did not report significant differences between younger and older patients …”

“…Satisfaction with esthetic outcome and scar quality were also associated with higher levels of overall quality of life …”

“…32 Satisfaction with esthetic outcome and scar quality were also associated with higher levels of overall quality of life. 31,50 Lastly, one study found that patients with a paternalistic decisionmaking process (vs informed) reported lower levels of physical function. 55…”

“…27,39 The remaining studies did not report significant differences between younger and older patients. 3,10,32,50,52,53,56,57 Four studies reported findings regarding marital status. One study reported that married women reported lower levels of overall quality of life, 3 while another study reported somewhat opposite results, since married women reported higher levels of psychosocial and sexual well-being.…”