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Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 13 September 2021

This article has been updated

Abstract

Background

Breast reconstruction is associated with improved patient well-being after mastectomy; however, factors that contribute to post-surgical dissatisfaction remain poorly characterized.

Methods

Adult women who underwent post-mastectomy implant-based or autologous breast reconstruction between 2015 and 2019 were recruited to participate in semi-structured interviews regarding their lived experiences with reconstructive care. Participants completed the BREAST-Q, and tabulated scores were used to dichotomize patient-reported outcomes as satisfied or dissatisfied (high or low) for each BREAST-Q domain. A convergent mixed-methods analysis was used to evaluate interviews for content related to satisfaction or dissatisfaction with breast reconstruction.

Results

Overall, we interviewed 21 women and identified 17 subcodes that corresponded with the five BREAST-Q domains. Sources of dissatisfaction were found to be related to the following domains: (a) low breast satisfaction due to asymmetry, cup size, and lack of sensation and physical feeling (n = 8, 38%); (b) poor sexual well-being due to shape, look and feel (n = 7, 78% [of 9 who discussed sexual well-being]); (c) reduced physical well-being of the chest due to persistent pain and weakness (n = 11, 52%); (d) reduced abdominal well-being due to changes in abdominal strength, numbness, and posture (n = 6, 38% [of 16 who underwent abdominally based reconstruction]); and (e) low psychosocial well-being impacted by an unexpected appearance that negatively influenced self-confidence and self-identity (n = 13, 62%).

Conclusion

Patients may be unprepared for the physical, sexual, and psychosocial outcomes of breast reconstruction. Targeted strategies to improve preoperative education and shared decision making are needed to mitigate unexpectedness associated with breast reconstruction and related outcomes.

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Acknowledgments

This project was supported by a pilot grant from the Plastic Surgery Foundation.

Funding

This study was supported by a pilot grant from the Plastic Surgery Foundation.

Author information

Authors and Affiliations

  1. Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA

    Ronnie L. Shammas MD, Amanda R. Sergesketter MD, Brett T. Phillips MD, Sachi Oshima BS & Scott T. Hollenbeck MD

  2. Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA

    Laura J. Fish PhD, MPH

  3. Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Laura J. Fish PhD, MPH & Clara N. Lee MD

  4. Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anaeze C. Offodile II MD, MPH

  5. Department of Surgery, Section Chief of Breast Surgery, Yale School of Medicine, DUMC 3513, New Haven, CT, 06511, USA

    Rachel A. Greenup MD, MPH

Authors
  1. Ronnie L. Shammas MD
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  2. Laura J. Fish PhD, MPH
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  7. Clara N. Lee MD
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  8. Scott T. Hollenbeck MD
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  9. Rachel A. Greenup MD, MPH
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Corresponding author

Correspondence to Rachel A. Greenup MD, MPH.

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Disclosure

Scott Hollenbeck is a co-founder of inSoma Bio, a consultant for True Digital Surgery, and has received book royalties from Elsevier. Ronnie L. Shammas, Laura J. Fish, Amanda R. Sergesketter, Anaeze C. Offodile II, Brett T. Phillips, Sachi Oshima, Clara N. Lee, and Rachel A. Greenup have no conflicts of interest to declare.

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The original online version of this article was revised: Amanda R. Sergesketter′s and Anaeze C. Offodile II′s names were corrected.

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Shammas, R.L., Fish, L.J., Sergesketter, A.R. et al. Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study. Ann Surg Oncol 29, 1109–1119 (2022). https://doi.org/10.1245/s10434-021-10720-9

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  • DOI: https://doi.org/10.1245/s10434-021-10720-9

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