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Determinants of Patients’ Choice of Reconstruction with Mastectomy for Primary Breast Cancer

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Abstract

Background: The aim of the study was to measure women’s decisions about breast reconstruction (BR) after mastectomy and to assess the factors contributing to their decisions, in a context involving shared decision-making and maximum patient autonomy.

Methods: Women who were about to undergo mastectomy for primary breast cancer were systematically offered choices concerning BR and time of reconstruction (intervention always covered by the French National Insurance System). Self-administered questionnaires were used prior to the operation.

Results: Among the 181 respondents, 81% opted for BR and 19% for mastectomy alone. In comparison with those who chose mastectomy alone, those opting for BR more frequently recognized the importance of discussing these matters with the surgeon and their partner (adjusted odds ratio [ORadj] = 13.45 and 3.59, respectively; P < .05) and realized that their body image was important (ORadj = 10.55, P < .01); fears about surgery prevented some of the women from opting for BR (ORadj = 0.688, P < .05). Among the women opting for BR, 83% chose immediate breast reconstruction (IBR) and 17% chose delayed breast reconstruction (DBR). The preference for IBR was mainly attributable to the fact that these women had benefited more frequently from doctor–patient discussions (ORadj = 3.49, P < .05) but was also attributable to the patients’ physical and functional characteristics: they were in a poorer state of health (P < .05). The surgeons predicted their patients’ preferences fairly accurately.

Conclusions: In a context of maximum autonomy, the great majority of the women chose IBR. The patients’ choices were explained mainly by their psychosocial characteristics. The indication for BR should be properly discussed between patients and surgeons before mastectomy.

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REFERENCES

  1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227–32.

    PubMed  Google Scholar 

  2. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333: 1456–61.

    Article  CAS  PubMed  Google Scholar 

  3. Moyer A. Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 1997; 16: 284–98.

    PubMed  CAS  Google Scholar 

  4. Lee JH, Glick HA, Hayman JA, Solin LJ. Decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy in high-risk premenopausal breast cancer patients. J Clin Oncol 2002; 20: 2713–25.

    PubMed  Google Scholar 

  5. Morrow M, Scott SK, Menck HR, et al. Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study. J Am Coll Surg 2001; 192: 1–8.

    PubMed  CAS  Google Scholar 

  6. Callaghan CJ, Couto E, Kerin MJ, et al. Breast reconstruction in the United Kingdom and Ireland. Br J Surg 2002; 89: 335–40.

    PubMed  CAS  Google Scholar 

  7. Harcourt D, Rumsey N. Psychological aspects of breast reconstruction: a review of the literature. J Adv Nurs 2001; 35: 477–87.

    PubMed  CAS  Google Scholar 

  8. Ringberg A, Tengrup I, Aspegren K, Palmer B. Immediate breast reconstruction after mastectomy for cancer. Eur J Surg Oncol 1999; 25: 470–6.

    PubMed  CAS  Google Scholar 

  9. Newman LA, Kuerer HM, Hunt KK, et al. Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surg Oncol 1999; 6: 671–5.

    PubMed  CAS  Google Scholar 

  10. Noone RB, Frazier TG, Noone GC, et al. Recurrence of breast carcinoma following immediate reconstruction: a 13-year review. Plast Reconstr Surg 1994; 93: 96–106;discussion 107–8.

    PubMed  CAS  Google Scholar 

  11. Sandelin K, Billgren AM, Wickman M. Management, morbidity, and oncologic aspects in 100 consecutive patients with immediate breast reconstruction. Ann Surg Oncol 1998; 5: 159–65.

    PubMed  CAS  Google Scholar 

  12. Styblo TM, Lewis MM, Carlson GW, et al. Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap. Ann Surg Oncol 1996; 3: 375–80.

    PubMed  CAS  Google Scholar 

  13. Rosenqvist S, Sandelin K, Wickman M. Patients’ psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 1996; 22: 262–6.

    PubMed  CAS  Google Scholar 

  14. Crespo LD, Eberlein TJ, O’Connor N, et al. Postmastectomy complications in breast reconstruction. Ann Plast Surg 1994; 32: 452–6.

    PubMed  CAS  Google Scholar 

  15. Tallet AV, Salem N, Moutardier V, et al. Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results. Int J Radiat Oncol Biol Phys 2003; 57: 136–42.

    PubMed  Google Scholar 

  16. Sprangers MA, Cull A, Groenvold M, et al. The European Organization for Research and Treatment of Cancer approach to developing questionnaire modules: an update and overview. EORTC Quality of Life Study Group. Qual Life Res 1998; 7: 291–300.

    CAS  PubMed  Google Scholar 

  17. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–76.

    Article  CAS  PubMed  Google Scholar 

  18. Fuhrer FRR. The french version of the center for Epidemiologic Studies-Depression Scale. Psychiatr Psychobiol 1989; 4: 163–6.

    Google Scholar 

  19. Radloff LS. The CES-D: A self-report depression scale for research in the general population. App Psychol Meas 1977; 3: 385–401.

    Google Scholar 

  20. Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 2000; 36: 1938–43.

    PubMed  CAS  Google Scholar 

  21. Schover LR, Yetman RJ, Tuason LJ, et al. Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer 1995; 75: 54–64.

    PubMed  CAS  Google Scholar 

  22. Schover LR. Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr 1994; 16: 177–82.

    PubMed  Google Scholar 

  23. Noguchi M, Kitagawa H, Kinoshita K, et al. Psychologic and cosmetic self-assessments of breast conserving therapy compared with mastectomy and immediate breast reconstruction. J Surg Oncol 1993; 54: 260–6.

    PubMed  CAS  Google Scholar 

  24. Mock V. Body image in women treated for breast cancer. Nurs Res 1993; 42: 153–7.

    PubMed  CAS  Google Scholar 

  25. Fallowfield LJ. Psychosocial adjustment after treatment for early breast cancer. Oncology (Huntingt) 1990; 4: 89–100.

    CAS  Google Scholar 

  26. Kemeny MM, Wellisch DK, Schain WS. Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer. Cancer 1988; 62: 1231–7.

    PubMed  CAS  Google Scholar 

  27. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1983; 1: 459–62.

    PubMed  CAS  Google Scholar 

  28. Hopwood P. The assessment of body image in cancer patients. Eur J Cancer 1993; 2: 276–81.

    Google Scholar 

  29. Clifford E, Clifford M, Georgiade NG. Breast reconstruction following mastectomy: II. Marital characteristics of patients seeking the procedure. Ann Plast Surg 1980; 5: 344–6.

    PubMed  CAS  Google Scholar 

  30. Rowland JH, Dioso J, Holland JC, et al. Breast reconstruction after mastectomy: who seeks it, who refuses? Plast Reconstr Surg 1995; 95: 812–23.

    Article  PubMed  CAS  Google Scholar 

  31. Reaby LL. Reasons why women who have mastectomy decide to have or not to have breast reconstruction. Plast Reconstr Surg 1998; 101: 1810–8.

    PubMed  CAS  Google Scholar 

  32. Charavel M, Bremond A. Motivations for breast reconstruction after mastectomy: a comparative study. Bull Cancer 1996; 83: 46–53.

    PubMed  CAS  Google Scholar 

  33. O’Brien W, Hasselgren PO, Hummel RP, et al. Comparison of postoperative wound complications and early cancer recurrence between patients undergoing mastectomy with or without immediate breast reconstruction. Am J Surg 1993; 166: 1–5.

    PubMed  CAS  Google Scholar 

  34. Noguchi M, Earashi M, Ohta N, et al. Mastectomy with and without immediate breast reconstruction using a musculocutaneous flap. Am J Surg 1993; 166: 279–83.

    PubMed  CAS  Google Scholar 

  35. Clough KB, Bourgeois D, Falcou MC, et al. Immediate breast reconstruction by prosthesis: a safe technique for extensive intraductal and microinvasive carcinomas. Ann Surg Oncol 1996; 3: 212–8.

    PubMed  CAS  Google Scholar 

  36. Morris J, Royle GT. Choice of surgery for early breast cancer: pre- and postoperative levels of clinical anxiety and depression in patients and their husbands. Br J Surg 1987; 74: 1017–9.

    PubMed  CAS  Google Scholar 

  37. Nissen MJ, Swenson KK, Ritz LJ, et al. Quality of life after breast carcinoma surgery: a comparison of three surgical procedures. Cancer 2001; 91: 1238–46.

    PubMed  CAS  Google Scholar 

  38. Stevens LA, McGrath MH, Druss RG, et al. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg 1984; 73: 619–28.

    Article  PubMed  CAS  Google Scholar 

  39. Malata CM, McIntosh SA, Purushotham AD. Immediate breast reconstruction after mastectomy for cancer. Br J Surg 2000; 87: 1455–72.

    PubMed  CAS  Google Scholar 

  40. August DA, Wilkins E, Rea T. Breast reconstruction in older women. Surgery 1994; 115: 663–8.

    PubMed  CAS  Google Scholar 

  41. Fallowfield LJ, Hall A, Maguire GP, Baum M. Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ 1990; 301: 575–80.

    Article  CAS  PubMed  Google Scholar 

  42. Ashcroft Psychosocial issues in malignant disease; mastectomy versus breast conservation. BPOS Proc 1984; 7–8.

  43. Degner LF, Kristjanson LJ, Bowman D, et al. Information needs and decisional preferences in women with breast cancer. JAMA 1997; 277: 1485–92.

    Article  CAS  PubMed  Google Scholar 

  44. Keating NL, Guadagnoli E, Landrum MB, et al. Treatment decision making in early-stage breast cancer: should surgeons match patients’ desired level of involvement? J Clin Oncol 2002; 20: 1473–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Inserm U379, Marseilles

    P. Ananian MD, C. Protière PhD, S. Arnaud MD, J.P. Moatti PhD & C. Julian-Reynier MD

  2. Institut Paoli-Calmettes, Marseilles

    G. Houvenaeghel MD, A. Tallet MD & A. C. Braud MD

  3. Centre Val d’Aurelle, Montpellier

    P. Rouanet MD

  4. Observatoire Régional de la Santé, Marseilles

    S. Arnaud MD

  5. Université de la Méditerranée, Marseilles, France

    J.P. Moatti PhD

  6. INSERM U379, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13273, Marseille Cedex 9, France

    C. Julian-Reynier MD

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  1. P. Ananian MD
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  2. G. Houvenaeghel MD
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Correspondence to C. Julian-Reynier MD.

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Ananian, P., Houvenaeghel, G., Protière, C. et al. Determinants of Patients’ Choice of Reconstruction with Mastectomy for Primary Breast Cancer. Ann Surg Oncol 11, 762–771 (2004). https://doi.org/10.1245/ASO.2004.11.027

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  • DOI: https://doi.org/10.1245/ASO.2004.11.027

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