Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice
- 416 Downloads
Many studies have explored women’s reasons for choosing or declining a particular type of breast reconstruction (BR) following mastectomy for breast cancer. This systematic review synthesises women’s reasons for choosing a range of BR options, including no BR, in different settings and across time.
Thirteen databases were systematically searched, with 30 studies (4269 participants), meeting the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, reasons and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Reasons were grouped into eight domains.
While study methodology and results were heterogeneous, all reported reasons were covered by the eight domains: Feeling/looking normal; Feeling/looking good; Being practical; Influence of others; Relationship expectations; Fear; Timing; and Unnecessary. We found a strong consistency in reasons across studies, ranging from 52% of relevant publications citing relationship expectations as a reason for choosing BR, up to 91% citing fear as a reason for delaying or declining BR. Major thematic findings were a lack of adequate information about BR, lack of genuine choice for women and additional access limitations due to health system barriers.
Understanding women’s reasons for wanting or not wanting BR can assist clinicians to help women make choices most aligned with their individual values and needs. Our thematic findings have equity implications and illustrate the need for surgeons to discuss all clinically appropriate BR options with mastectomy patients, even if some options are not available locally.
KeywordsBreast cancer Breast reconstruction Patient-reported outcome measures Quality of life Reasons
The I-BREAST study is generously funded by The Friends of the Mater Foundation, North Sydney, Australia. The study sponsors did not influence the study design, collection, analysis or interpretation of data, or the writing of the manuscript. We also acknowledge the assistance of Ngaire Pettit-Young (Information Specialist, Information First) in conducting the literature search.
Compliance with ethical standards
Conflict of interest
All authors declare there are no conflicts of interest.
This systematic review was conducted under the auspices of the Improving Breast Reconstruction Equity of Access through Stakeholder consultation and Translation into Policy and Practice (I-BREAST) study. Ethics approval for I-BREAST was obtained from StVincent’s Hospital, Sydney, Human Research Ethics Committee (14/181). I-BREAST is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR number 12616000188437). Separate ethics approval was not required for this systematic review.
- 1.Australian Institute of Health and Welfare & Cancer Australia (2012). Breast cancer in Australia: An overview. Cancer series no. 71. Cat. no. CAN 67. Canberra: AIHW.Google Scholar
- 2.National Clinical Audit Support Programme (2009). National Mastectomy and Breast Reconstruction Audit (Report 2). London: The Information Centre (NHS).Google Scholar
- 7.Atisha, D., Alderman, A. K., Lowery, J. C., Kuhn, L. E., Davis, J., & Wilkins, E. G. (2008). Prospective analysis of long-term psychosocial outcomes in breast reconstruction: Two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Annals of Surgery, 247(6), 1019–1028. doi: 10.1097/SLA.0b013e3181728a5c.CrossRefPubMedGoogle Scholar
- 11.Metcalfe, K. A., Semple, J., Quan, M.-L., Vadaparampil, S. T., Holloway, C., Brown, M., et al. (2012). Changes in psychosocial functioning one year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction. Annals of Surgical Oncology, 19(1), 233–241.CrossRefPubMedGoogle Scholar
- 20.Lardi, A. M., Myrick, M. E., Haug, M., Schaefer, D. J., Bitzer, J., Simmen, U., et al. (2013). The option of delayed reconstructive surgery following mastectomy for invasive breast cancer: Why do so few patients embrace this offer? European Journal of Surgical Oncology, 39, 36–43.CrossRefPubMedGoogle Scholar
- 24.Adachi, K., Ueno, T., Fujioka, T., Fujitomi, Y., & Ueo, H. (2007). Psychosocial factors affecting the therapeutic decision-making and postoperative mood states in Japanese breast cancer patients who underwent various types of surgery: Body image and sexuality. Japanese Journal of Clinical Oncology, 37(6), 412–418.CrossRefPubMedGoogle Scholar
- 27.Alderman, A. K., Hawley, S. T., Janz, N. K., Majahid, M. S., Morrow, M., Hamilton, A. S., et al. (2009). Racial and ethnic disparities in the use of postmastectomy breast reconstruction: Results from a population-based study. Journal of Clinical Oncology, 27, 5325–5330.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Neill, K. M., Armstrong, N., & Burnett, C. B. (1988). Choosing reconstruction after mastectomy: A qualitative analysis. Oncology Nursing Forum, 25(4), 743–750.Google Scholar
- 38.Kmet, L. M., Lee, R. C., & Cook, L. S. (2004). Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Health Technology Assessment Initiative No. 13. February 2004. Alberta: Alberta Heritage Foundation for Medical Research.Google Scholar
- 41.Breast Cancer Network Australia (BCNA) (2013). Issue of concern. Breast reconstruction. The Beacon, 63, 3.Google Scholar
- 42.Breast Cancer Network Australia (BCNA) (2011). Breast reconstruction project report November 2011, Melbourne: BCNA. [2010 survey available from: http://www.bcna.org.au/sites/default/files/breast-reconstruction-report.pdf.].
- 43.Clifford E. (1979). The reconstruction experience: The search for restitution. In NG Georgiade (Ed.), Breast reconstruction following mastectomy (pp. 22–34). St Louis,MO: CV Mosby.Google Scholar
- 55.Zieliński T, Lorenc-Podgórska K, Antoszewski B. (2014). Why women who have mastectomy decide not to have breast reconstruction? Polski Przegląd Chirurgiczny, 86 (10), 451–455.Google Scholar
- 56.Mátrai, Z., Kenessey, I., Sávolt Á, Újhelyi, M., Bartal, A., & Kásler, M. (2014). Evaluation of patient knowledge, desire, and psychosocial background regarding postmastectomy breast reconstruction in Hungary: A questionnaire study of 500 cases. Medical Science Monitor, 20, 2633–2642.CrossRefPubMedPubMedCentralGoogle Scholar
- 57.Cancer Australia. (2001) Clinical practice guidelines for the management of early breast cancer (2nd edn). Retrieved July, 5 2016, from http://canceraustralia.gov.au/publications-resources/cancer-australia-publications/clinical-practice-guidelines-management-early.
- 58.National Comprehensive Cancer Network.(2013) NCCN guidelines Version 3. Breast cancer. Retrieved July 5, 2016, from http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
- 59.National Institute for Health and Care Excellence (NICE) (2009) Guidelines. Breast cancer (Early & Locally Advanced). Breast cancer. Retrieved July 5, 2016, from http://www.nice.org.uk/guidance/CG80.
- 60.Cancer Australia. (2016) Influencing best practice in breast cancer Retrieved July 5, 2016, from https://thestatement.canceraustralia.gov.au/.
- 63.National Breast and Ovarian Cancer Centre (NBOCC) and the Royal Australasian College of Surgeons (RACS) (2009). National Breast Cancer Audit—Public Health Monitoring Report on 2007 Data. Sydney: NBOCC and RACS.Google Scholar
- 65.Takahashi, M., Kai, I., Hisata, M., & Higashi, Y. (2006). The association between breast surgeons’ attitudes toward breast reconstruction and their reconstruction-related information-giving behaviors: A nationwide survey in Japan. Plastic & Reconstructive Surgery, 118(7), 1507–1514.CrossRefGoogle Scholar
- 72.Brennan, M. E., Flitcroft, K., Warrier, S., Snook, K., & Spillane, A. (2016). Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer. The Breast, 30, 59–65.CrossRefPubMedGoogle Scholar