Less Than Half of Mastectomy Patients Make ‘High-Quality’ Reconstruction Choices, Study Says

Whether or not to get reconstructive surgery and what kind of reconstruction to get following a mastectomy are two very personal and sometimes difficult decisions. But a study published in JAMA Surgery has shown that perhaps you shouldn’t be the only one involved in making the choice.

The study involved 126 women being treated at the North Carolina Cancer Hospital. Researchers surveyed the patients about their knowledge of mastectomies and reconstruction, including what they knew about the risks, recovery time, the affect of surgery on the appearance of the breasts, women’s satisfaction rates, risk of recurrence, and more. They also asked about their values and what mattered most to them after surgery, such as breast shape or appearance, risks, recovery time, and number of procedures.

Roughly 57 percent of patients were found to have made reconstruction decisions that were poorly aligned with their post-surgery priorities. 82 of the participants in the study reported preferring to have a mastectomy with no reconstruction, and yet only 39 of those women acted on that preference. Another 41 women preferred a mastectomy with reconstruction, but only 36 of those women went through with reconstruction.

Photo: Adobe Stock/branislavp
Photo: Adobe Stock/branislavp

Just 43 percent of the patients involved in the study were judged to have made “high-quality” decisions regarding reconstruction.

“We found that about 60 percent had adequate knowledge and about 60 percent had treatment that fit their preferences,” said lead author Dr. Clara Lee, of the Ohio State University Comprehensive Cancer Center – Arthur G James Cancer Hospital and Richard J Solove Research Institute in Columbus.

The reality is that, while reconstruction is the patient’s choice, it is important for doctors to provide enough information about their patients’ options to help them make decisions that match their priorities. For example, for a woman who was happy with her relatively flat chest before surgery and whose main concern is the risk of death and the inconvenience of multiple surgeries and recoveries, the decision to forego reconstruction and “go flat” may make the most sense. However, if the woman does not fully understand the risks and expectations of reconstruction—or worse, if the option to skip reconstruction is not presented to her at all—she may not make the best decision for her.

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Photo: Adobe Stock/zinkevych
Photo: Adobe Stock/zinkevych

Here are some questions to ask yourself when considering reconstructive surgery following a mastectomy:

  1. How much do you care about the size and shape of your breasts and what others think about them?
  2. Do you think breasts are essential to womanhood?
  3. How much do you care about the number of surgeries required for the different reconstruction options?
  4. How difficult was recovery for your mastectomy?
  5. Do you have a firm grasp on the risks involved with surgeries and implants?

In the end, you’ll have to make your own choice about breast reconstruction. Until you’re actually confronted with the difficult decision, there’s no telling what you would really do. It’s so important that we stop judging one another for our decisions so that we can all be free to make scary and personal choices like this one without worrying about what everyone else will think.

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