Quality of Life Research

, Volume 26, Issue 9, pp 2287–2319 | Cite as

Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice




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.


Breast 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.

Ethics approval

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.

Supplementary material

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Online resource 1 (PDF 36 KB)
11136_2017_1555_MOESM2_ESM.pdf (43 kb)
Online resource 2 (PDF 42 KB)


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Breast & Surgical Oncology at The Poche CentreNorth SydneyAustralia
  2. 2.Northern Clinical SchoolUniversity of SydneySydneyAustralia

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