Patients Undergoing Bilateral Mastectomy and Breast-Conserving Surgery Have the Lowest Levels of Regret: The WhySurg Study

Deliere, Amanda; Attai, Deanna J.; Victorson, David; Kuchta, Kristine; Pesce, Catherine; Kopkash, Katherine; Sisco, Mark; Seth, Akhil K.; Yao, Katharine

doi:10.1245/s10434-021-10452-w

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…In the Deliere et al 18 study, BM and BM+R had the lowest proportion of women with high decisional regret (10% for BM and 9% for BM+R), and BM was associated with significantly less regret than UM in the multivariable analysis (OR, 0.40; P < 0.001). Complications after reconstructive surgery increased the degree of decisional regret experienced, but was lowest overall among the BM patients of all the surgical types after adjustment for clinical factors.…”

Section: Resultsmentioning

confidence: 88%

“…Complications after reconstructive surgery increased the degree of decisional regret experienced, but was lowest overall among the BM patients of all the surgical types after adjustment for clinical factors. 18 Huang and Chagpar 20 demonstrated greater satisfaction with decision among women undergoing BM+R than among those undergoing BM, but this difference was not statistically significant (OR, 5.83 for autologous and 4.01 for implant reconstruction vs. no reconstruction; p = 0.306).…”

Section: Resultsmentioning

confidence: 90%

“…1 ). The review included 15 papers reporting outcomes from 13 quantitative studies, 18 – 30 1 qualitative study, 31 and 1 mixed-methods study 32 (Fig. 1 ; Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies evaluated patients’ satisfaction with their decision (SWD) to have surgery. 18 , 20 , 32 Although different measures were used, all three studies found that the women were highly satisfied with their decision to have surgery (Table 4 ). Baker et al 32 showed that 74.1% of women were satisfied with BM results and that low satisfaction was associated most strongly with poor surgeon support around decision-making.…”

Section: Resultsmentioning

confidence: 99%

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Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review

Griffin,

Fairhurst,

Stables

et al. 2023

Ann Surg Oncol

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Background Breast reconstruction (BR) is routinely offered to restore symmetry after mastectomy for breast cancer. Not all women, however, may want reconstructive surgery. A contralateral mastectomy (CM) to achieve “flat symmetry” can be an excellent alternative, but surgeons are often reluctant to offer this procedure. This systematic review aimed to summarize the available evidence regarding the outcomes of CM as the first step to developing guidelines in this area. Methods PubMed, MEDLINE, CINAHL and PsycINFO were searched to identify primary research studies, published in English between 1 January 2000 and 30 August 2022, evaluating clinical or patient-reported outcomes for women who underwent a CM without reconstruction after a mastectomy for unilateral breast cancer. Simple descriptive statistics summarized quantitative data, and content analysis was used for qualitative data. Results The study included 15 studies (13 quantitative, 1 qualitative, and 1 mixed-methods) evaluating outcomes for at least 1954 women who underwent a bilateral mastectomy without reconstruction (BM) after unilateral breast cancer. The risk of surgical complications after BM was higher than after unilateral mastectomy without reconstruction (UM) but significantly less than after BR. Satisfaction with the decision for BM was high in all the studies. Key themes relating to flat denial, stigma, and gender-based assumptions were identified. Conclusion Women electing to undergo BM reported high levels of satisfaction with their decision and complication rates similar to those for UM. Further study is needed to comprehensively explore the outcomes for women seeking BM, but these data should give surgeons confidence to offer the procedure as an alternative option for symmetry after unilateral mastectomy for breast cancer. Registration: This systematic review was prospectively registered on the PROSPERO database (CRD42022353689).

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 90%

“…1 ). The review included 15 papers reporting outcomes from 13 quantitative studies, 18 – 30 1 qualitative study, 31 and 1 mixed-methods study 32 (Fig. 1 ; Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review

Griffin,

Fairhurst,

Stables

et al. 2023

Ann Surg Oncol

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“…An MBC patient experience survey was developed to assess the level of information patients received about surgical choices and comfort with the appearance of their chest wall and scar after surgery. The survey items were chosen based on another survey of women with breast cancer, the WhySurg study, 18 in which women were asked about surgical choice and their decisional satisfaction. The MBC survey was examined and tested by five MBC patients in the community for readability, vocabulary, and time to complete it before its official launching.…”

Section: Methodsmentioning

confidence: 99%

Male Breast Cancer Patient and Surgeon Experience: The Male WhySurg Study

et al. 2022

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Background Little is known about the experience of the male breast cancer patient. Mastectomy is often offered despite evidence that breast-conserving surgery (BCS) provides similar outcomes. Methods Two concurrent online surveys were distributed from August to October 2020 via social media to male breast cancer (MBC) patients and by email to American Society of Breast Surgeon members. The MBC patients were asked their opinions about their surgery, and the surgeons were asked to provide surgical recommendations for MBC patients. Results The survey involved 63 MBC patients with a mean age of 62 years (range, 31–79 years). Five MBC patients (7.9 %) stated that their surgeon recommended BCS, but 54 (85.7 %) of the patients underwent unilateral, and 8 (12.7 %) underwent bilateral mastectomy. Most of the patients ( n = 60, 96.8 %) had no reconstruction. One third of the patients ( n = 21, 33.3 %) felt somewhat or very uncomfortable with their appearance after surgery. The response rate was 16.5 % for the surgeons. Of the 438 surgeons who answered the survey, 298 (73.3 %) were female, 215 (51.7 %) were fellowship-trained, and 244 (58.9 %) had been practicing for 16 years or longer. More than half of surgeons ( n = 259, 59.1 %) routinely offered BCS to eligible men, and 180 (41.3 %) stated they had performed BCS on a man with breast cancer. Whereas 89 (20.8 %) of the surgeons stated that they routinely offer reconstruction to MBC patients, 87 (20.3 %) said they do not offer reconstruction, 96 (22.4 %) said they offer it only if the patient requests it, and 157 (36.6 %) said they never consider it as an option. Conclusions The study found discordance between MBC patients’ satisfaction with their surgery and surgeon recommendations and experience. These data present an opportunity to optimize the MBC patient experience.

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Decision Regret in Plastic Surgery: A Summary

Jones

Cruz

Stewart

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Patient decision regret can occur following elective healthcare decisions. The current era is focused on patient-reported outcomes, and decision regret is another metric by which surgeons can and should measure postoperative results. Patients who experience decision regret after elective procedures can often blame themselves, the surgeon, or the clinical practice, and this can lead to downstream psychological and economic consequences for all parties involved. Methods: A literature search was conducted on PubMed using the following search terms: (aesthetic surgery) AND (decision regret), (rhinoplasty) AND (decision regret), (face-lift) AND (decision regret), (abdominoplasty) AND (decision regret), (breast augmentation) AND (decision regret), (breast reconstruction) AND (decision regret), (FACE-Q) AND (rhinoplasty), (BREAST-Q) AND (breast augmentation). The following article types were included in the search: randomized controlled trials, meta-analysis, and systematic reviews. Results: After review of the literature, preoperative education, decisional tools, and postoperative complications were found to be the most important factors affecting decision regret after surgery. Conclusions: A better understanding of the factors associated with decision regret can help surgeons provide more effective preoperative counseling and prevent postoperative decision regret. Plastic surgeons can use these tools within a context of shared decision-making and ultimately increase patient satisfaction. Decision regret for plastic surgical procedures was mainly in the context of breast reconstruction. The differences in medical necessity create unique psychological challenges, emphasizing the need for more studies and a better understanding of the topic for other elective and cosmetic surgery procedures.

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Patients Undergoing Bilateral Mastectomy and Breast-Conserving Surgery Have the Lowest Levels of Regret: The WhySurg Study

Cited by 6 publications

References 34 publications

Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review

Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review

Male Breast Cancer Patient and Surgeon Experience: The Male WhySurg Study

Decision Regret in Plastic Surgery: A Summary

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