Breast reconstruction decisions reveal different values held by women

Key takeaways:

• Abdominal morbidity was an important consideration for choosing implant-based vs. flap reconstruction.
• Annual income greater than $75,000 was linked to a lower likelihood of choosing flap reconstruction.

Women who choose autologous or implant-based breast reconstruction value different aspects of their treatment compared with those who choose flap breast reconstruction, researchers reported in JAMA Surgery.

“Patients make a series of complex decisions at the time of breast cancer diagnosis and may have trouble processing decisions related to breast cancer treatment and reconstruction, resulting in some patients experiencing decisional regret after surgery,” Ronnie L. Shammas, MD, house staff in the division of plastic, maxillofacial and oral surgery at Duke University, and colleagues wrote. “Thus, it is essential to understand which aspects of breast reconstruction are most important to each patient when making patient-centered treatment decisions.”

Shammas and colleagues conducted a web-based, cross-sectional study with 105 women (mean age, 46.3 years) from Duke University with a new diagnosis of or a genetic predisposition to breast cancer who were considering mastectomy with reconstruction and 301 women (mean age, 59.2 years) from the Love Research Army registry with breast cancer history or a genetic predisposition.

According to the results, women in this study considered risk for abdominal morbidity as the most important attribute of breast reconstruction (28%), followed by major complication risk (25%), additional operations (23%), appearance of the breasts (13%) and recovery time (11%). Overall, 85% of participants preferred implant-based breast reconstruction, and these participants cited top decision factors of abdominal morbidity (30%), major complications risk (26%) and additional operations (21%).

Women who preferred flap breast reconstruction cared about additional operations (31%), appearance of the breasts (27%) and major complications risk (18%).
P = .04) and having a higher educational level (OR = 2.43; 95% CI, 1.01-5.86; P = .04) as factors independently associated with choosing flap breast reconstruction. In contrast, having an income level greater than $75,000 annually was associated with a decreased likelihood of choosing flap reconstruction (OR = 0.45; 95% CI, 0.21-0.97; P = .01).

Those preferring flap reconstruction appearance were willing to accept a mean increase of 14.9% chance of abdominal morbidity or 6.4% chance of major complications.

“Ultimately, these findings lay the foundation for the development of decision support tools that elicit individual-level preferences for breast reconstruction and actively promote patient-physician discussions that incorporate patient preferences in decisions for treatment,” the researchers wrote.