Accuracy of Predictions of Patients with Breast Cancer of Future Well-being After Immediate Breast Reconstruction

Authors: Lee, C. et. al.

Source: JAMA Surg doi:10.1001/jamasurg.2017.6112

jamanetwork.com/journals/jamasurgery/article-abstract/2671391

Commonly, women who are planning to have mastectomy for breast cancer or cancer risk reduction are offered reconstruction. Their decision-making processes are unique and care teams work closely with them as they make their choices. The investigators noted that people tend to overestimate the significance that a life event will have on future well-being. They also noted that 9-20% of women who have reconstruction with mastectomy experience regret. This study explored the accuracy of women’s own predictions of their quality of life with and without reconstruction following mastectomy.

Almost 100 women participated in the study. Over 70% of them had mastectomies for breast cancer treatment; the remainder had mastectomies for risk reduction. The mean age was 53 years. Seventy eight percent of the participants were white. Almost half were college graduates.  Over 60% of them were partnered and over 50% of them had private health insurance.

Fifty six percent of the women did not have reconstruction, and 44% did.

Participants completed surveys prior to surgery to assess quality of life, satisfaction with breasts, sexual attractiveness, numbness and pain. Women were asked to record their current responses and to predict their responses 12 months into the future. Surveys were repeated 6, 12 and 18 months after surgery.

The women who did not have reconstruction underestimated their quality of life 12 months after surgery. They also underestimated their satisfaction with breast appearance and sexual attractiveness (although they overestimated their predicted unclothed sexual attractiveness). Women who did have reconstruction overestimated their predicted quality of life, breast satisfaction and sexual attractiveness 12 months later.

Both groups expected postoperative numbness but underestimated the extent of it. Both groups also expected postoperative pain, but women who decided against reconstruction had more pain than they expected.

The researchers commented that while people have a strong ability to adapt to adversity, they tend to be unaware of that ability and neglect to include it in their decision-making. Women dealing with mastectomy for breast cancer may not realize how well they may adapt to the loss of a breast.They may also not completely grasp that scarring, pain and repeat operations can have negative impacts. Perhaps women do not realize that many other factors besides the presence of a breast contribute to a sense of well-being. Moreover, some patients may confuse aesthetic plastic surgery (i.e., breast augmentation) with reconstructive plastic surgery.

This study calls attention to what a woman’s expectations are after mastectomy. This information provides opportunities for surgical oncologists and plastic surgeons to have deeper conversations with their patients as part of the decision-making process in order to reduce the possibility of postoperative regret.