Summary
Introduction
Patients undergoing mastectomy and immediate breast reconstruction for cancer may
be expected to have different perceptions of long-term outcomes compared with those
who have this operation prophylactically.
Methods
Patients who underwent bilateral mastectomy and breast reconstruction from 2008 to
2014 at the Cambridge Breast Unit were identified from a prospective register and
their notes were audited. They were classified according to their indication for surgery
as follows: bilaterally therapeutic, bilaterally risk-reducing or combination. The
BREAST-Q™ questionnaire was posted to participants using the ‘total Dillman method’.
Q-SCORE software was utilised to analyse patient satisfaction scores.
Results
Sixty-five (58%) responses were received, of which 8 were excluded, leaving 57 usable
for the study. The therapeutic group had higher patient satisfaction than the risk-reducing
group across most domains including breast, outcome, psychosocial, sexual, physical
and information. The combination group scored lower and BRCA gene mutation-positive
patients scored the lowest. Physical well-being was maintained across all groups but
psychosocial/sexual well-being varied. Good psychosocial well-being was linked to
a higher satisfaction with the outcome in the combination and risk-reducing groups.
Conclusion
This study highlights the need for clinicians to take into account the indication
for surgery as a major psychological factor in patients’ perception of self and experience
of surgery. It demonstrates that bilateral immediate reconstruction patients report
similar physical symptoms irrespective of indication for mastectomy, but the decision-making
process in terms of risk-balancing and diagnosis influences satisfaction with self
and surgery. It underlines the importance of preoperative management of expectations
for patients undergoing risk-reducing procedures.
Keywords
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Article info
Publication history
Published online: June 27, 2018
Accepted:
June 16,
2018
Received in revised form:
May 24,
2018
Received:
August 19,
2017
Identification
Copyright
© 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
