Summary
Background
Utilization of bilateral prophylactic mastectomy (BPM) and reconstruction has increased
secondary to numerous medical advances. The purpose of this study was to examine decision
making in women electing this therapy to further understand what influences and drives
this decision.
Methods
The authors conducted a survey study, enrolling patients who elected BPM and reconstruction.
Participants were mailed structured questionnaires utilizing validated and study specific
tools addressing: demographics, treatment decisions, autonomy, decision making and
information seeking preferences, and breast cancer treatment knowledge. Analysis was
performed overall and by reconstruction.
Results
40 patients responded (20 autologous, 19 implant and 1 combination, 66% response rate).
The cohort was well educated and wealthy. Reconstructive options played a large role
in the consideration of BPM. Patients were influenced by their physicians and less
so by non-traditional means (media, internet, etc). Autologous reconstructions had
a stronger desire to utilize their own tissue (p < 0.001) and were less concerned with the amount of surgery (0.02) and resulting
scars (p = 0.01). Implant reconstructions more often stated that they did not have enough
tissue for autologous reconstruction (p < 0.001) and did have a lower BMI, 24.2 vs. 27.5 (p = 0.03). Additionally, they were more influenced by non-traditional means (p < 0.001) and by other patients (p = 0.02).
Conclusions
Multiple factors influence decision making in BPM and reconstruction, with the ultimate
choice in reconstruction involving tissue availability, appearance of implant reconstructions,
total amount of surgery required, and extent of visible scars. Patients were strongly
influenced by their physicians, and less so by non-traditional means.
Keywords
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References
- Increasing incidence of bilateral mastectomies: the patient perspective.Am J Surg. 2011; 201: 615-618
- The increasing use of prophylactic mastectomy in the prevention of breast cancer.Curr Oncol Rep. 2010; 12: 16-21
- Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment.J Clin Oncol. 2007; 25: 5203-5209
- Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer.Ann Surg Oncol. 2009; 16: 2697-2704
- Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution.Ann Surg Oncol. 2009; 16: 2691-2696
- Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey.Ann Surg. 2011; 253: 1147-1154
- Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction.J Plast Reconstr Aesthet Surg. 2008; 61: 1177-1187
- Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction.Plast Reconstr Surg. 2008; 122: 1-9
- High satisfaction rate ten years after bilateral prophylactic mastectomy - a longitudinal study.Eur J Cancer Care (Engl). 2011; 20: 508-513
- Information-seeking behaviour and coping style of women opting for either implant or DIEP-flap breast reconstruction.J Plast Reconstr Aesthet Surg. 2011; 64: 1167-1173
- Women's motives to opt for either implant or DIEP-flap breast reconstruction.J Plast Reconstr Aesthet Surg. 2011; 64: 1062-1067
- Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy.Jama. 2000; 284: 319-324
- Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer.Cancer. 2008; 112: 489-494
- Factors associated with patient involvement in surgical treatment decision making for breast cancer.Patient Educ Couns. 2007; 65: 387-395
- Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients.J Gen Intern Med. 1989; 4: 23-30
- Increasing patient involvement in choosing treatment for early breast cancer.Cancer. 1995; 76: 2275-2285
- The lifetime risk of developing breast cancer.J Natl Cancer Inst. 1993; 85: 892-897
- Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies.Am J Hum Genet. 2003; 72: 1117-1130
- Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers.J Clin Oncol. 2004; 22: 2328-2335
- Contralateral breast carcinoma: an assessment of risk and prognosis in stage I (T1N0M0) and stage II (T1N1M0) patients with 20-year follow-up.Surgery. 1989; 106: 904-910
- Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project.J Clin Oncol. 2005; 23: 4275-4286
- Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group.J Clin Oncol. 2004; 22: 1055-1062
- Technical aspects and outcome after prophylactic mastectomy and immediate breast reconstruction in 30 consecutive high-risk patients.Plast Reconstr Surg. 2003; 111: 1069-1077
- Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.J Clin Oncol. 2001; 19: 3938-3943
- When informed, all women do not prefer breast conservation.J Clin Oncol. 2009; 27: 484-486
- Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging.J Clin Oncol. 2009; 27: 4082-4088
- Are mastectomy rates really increasing in the United States?.J Clin Oncol. 2010; 28: 3437-3441
- Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy.Cancer Prev Res (Phila). 2010; 3: 1026-1034
- Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: the Hereditary Breast Cancer Clinical Study Group.J Clin Oncol. 2008; 26: 1093-1097
- Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors.Breast Cancer Res Treat. 2007; 104: 321-329
- One year follow-up of women opting for presymptomatic testing for BRCA1 and BRCA2: emotional impact of the test outcome and decisions on risk management (surveillance or prophylactic surgery).Breast Cancer Res Treat. 2002; 73: 97-112
- Personal health behaviors in women who have undergone risk-reducing mastectomy.Am J Surg. 2004; 188: 448-449
- Bilateral prophylactic mastectomy decision making: a vignette study.Prev Med. 1999; 29: 216-221
- Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States.Am J Surg. 2009; 198: 237-243
- Changing trends in recipient vessel selection for microvascular autologous breast reconstruction: an analysis of 1483 consecutive cases.Plast Reconstr Surg. 2007; 119: 1993-2000
- Correlates of breast reconstruction: results from a population-based study.Cancer. 2005; 104: 2340-2346
- Is pregnancy contraindicated following free TRAM breast reconstruction?.J Plast Reconstr Aesthet Surg. 2006; 59: 556-559
- Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors.J Natl Cancer Inst. 2000; 92: 1422-1429
- What women wish they knew before prophylactic mastectomy.Cancer Nurs. 2007; 30 (quiz 292–283): 285-291
- Immediate breast reconstruction in breast cancer: morbidity and outcome.Am Surg. 1998; 64: 1195-1199
- Immediate breast reconstruction: reducing the risks.Plast Reconstr Surg. 1989; 83: 845-851
- Options and considerations in the timing of breast reconstruction after mastectomy.Cleve Clin J Med. 2008; 75 (1S30-33)
Article info
Publication history
Published online: May 28, 2012
Accepted:
May 1,
2012
Received:
February 10,
2012
Footnotes
☆This manuscript was presented at the 54th Annual Meeting of the Ohio Valley Society of Plastic Surgeons conjoined with the Ivy Society of Plastic Surgery. June 2–4 2008. White Sulfur Springs, West Virginia.
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
