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

From Inserm U379 (PA, CP, SA, JPM, CJ-R), Institut Paoli-Calmettes (PA, GH, AT, ACB), Marseilles; Centre Val d’Aurelle (PR), Montpellier; Observatoire Régional de la Santé (SA), Marseilles; and Université de la Méditerranée (JPM), Marseilles, France.

Correspondence: Address correspondence and reprint requests to: Claire Julian-Reynier, MD, INSERM U379, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13273 Marseille Cedex 9, France; Fax: 33-491-223-504; E-mail: julian{at}marseille.inserm.fr

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 [OR_adj] = 13.45 and 3.59, respectively; P < .05) and realized that their body image was important (OR_adj = 10.55, P < .01); fears about surgery prevented some of the women from opting for BR (OR_adj = 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 (OR_adj = 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.

Key Words: Breast cancer • Mastectomy • Preferences • Reconstruction • Shared decision-making

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