Women’s motives to opt for either implant or DIEP-flap breast reconstruction

https://doi.org/10.1016/j.bjps.2011.03.030Get rights and content

Summary

Objective

Understanding women’s motives concerning breast reconstructive surgery will contribute to a better counselling and care for the increasing number of women choosing post-mastectomy breast reconstruction (BR).

Methods

We interviewed 31 women who opted for implant or deep inferior epigastric perforator (DIEP)-flap BR after therapeutic or prophylactic mastectomy. Motives for BR in general and for the selected type of BR were investigated following a phenomenological qualitative research approach.

Results

Women opting for implant BR were concerned with surgery-related issues, such as recovery time, number of scars and impact of surgery. They wanted to return to their daily life and restore their body image as soon as possible. Patients choosing DIEP-flap BR were more focussed on regaining a natural breast and wanted to benefit from the advantages of autologous tissue. Women scheduled for prophylactic mastectomy saw BR as an integral part of their treatment. Patients opting for BR after therapeutic mastectomy wanted to regain a complete body image with BR.

Conclusions

Patients’ motives for implant BR were primarily related to surgical issues, whereas women who chose DIEP-flap BR especially focussed on regaining a breast that resembles their own lost breast as well as possible. Clinical variables (such as therapeutic or prophylactic mastectomy, breast irradiation, and waiting lists) need to be taken into account when considering a certain type of BR, as these can be of great importance in the decision-making process.

Section snippets

Participants

Women who participated in a multicentre prospective follow-up questionnaire study on the psychological effects of different types of BR and who also consented to be interviewed were included. They had previously undergone mastectomy or were about to have therapeutic mastectomy for breast cancer (BC) or prophylactic mastectomy (PM) for a high-risk for developing BC. Exclusion criteria were previous BR and poor command of the Dutch language.

We used the method of purposive sampling, the most

Results

The interviews were planned on average 16.8 days (range 2–65 days) preoperatively and mean interview duration was 54 min (range 28–111 min).

Discussion

The main goal of the current study was to explore motives for choosing specific types of BR after therapeutic mastectomy as well as PM. Motives for choosing BR, in general, were consistent with previous findings.16, 19, 20 The most mentioned reasons to choose BR were feeling too young to live without breasts, wanting to avoid an external prosthesis and wishing to feel feminine and self-confident. Regarding the decision-making process of the specific type of BR, it remains difficult to

Acknowledgements

We thank all participants, the plastic surgeons G. K. van Drunen, J. F. A. van der Werff, J. Zguricas, N. A. S. Posch and M. J. I. Braam, their personal assistants S. M. van der Kroft-Mieog, I. Velders and E. Alblas-Groeneveld and nurse practitioner E. M. M. Krol-Warmerdam for referring potential candidates for the study to us.

References (39)

  • L. Manderson et al.

    The absent breast: speaking of the mastectomied body

    Feminism & Psychology

    (2007)
  • E.G. Wilkins et al.

    Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study

    Plast Reconstr Surg

    (2000)
  • C.K. Christian et al.

    A multi-institutional analysis of the socioeconomic determinants of breast reconstruction - A study of the National Comprehensive Cancer Network

    Ann Plast Surg

    (2006)
  • M. Morrow et al.

    Correlates of breast reconstruction - results from a population-based study

    Cancer

    (2005)
  • A.P. Polednak

    How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases

    Plast Reconstr Surg

    (2001)
  • J.Y. Chen et al.

    Variation in physician-patient discussion of breast reconstruction

    J Gen Intern Med

    (2009)
  • L. Eldor et al.

    Breast reconstruction after bilateral prophylactic mastectomy in women at high risk for breast cancer

    Breast J

    (2009)
  • C.N. Lee et al.

    What are patients’ goals and concerns about breast reconstruction after mastectomy?

    Ann Plast Surg

    (2010)
  • L.L. Reaby

    Reasons why women who have mastectomy decide to have or not to have breast reconstruction

    Plast Reconstr Surg

    (1998)
  • Cited by (0)

    View full text