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Understanding Decision-Making in Breast Reconstruction Following Mastectomy: Barriers to Follow-Through With Delayed Reconstruction
*Aleksandra Ogrodnik1, Ted James2
1Danbury Hospital, Danbury, CT;2University of Vermont-Fletcher Allen Health Center, Burlington, VT
Objective: Rates of breast reconstruction following mastectomy vary widely, and little is known about why women who originally express interest in reconstruction do not receive it. The goal of this study was to explore patterns in delayed reconstruction to identify possible barriers and factors associated with follow-through with delayed reconstruction.
Design: A retrospective chart review of women undergoing mastectomy from 2008 to 2012.
Setting: A single academic medical center in New England.
Patients: 367 women who have undergone a mastectomy.
Intervention: Mastectomy.
Main outcome measures: rates of immediate vs. delayed post-mastectomy breast reconstruction. Secondary measures included patient demographics, cancer stage, co-morbidity index, post-mastectomy reconstruction status, as well as documented decision-making regarding reconstruction.
Results: Of 219 women who had a mastectomy without immediate reconstruction, 5.9% completed delayed reconstruction, 21.9% expressed interest but were still pending reconstruction, 24.6% expressed no interest, and 47.5% lacked documentation regarding decision-making for breast reconstruction. Median follow-up was 2 years 10 months (range 10 to 69 months). Reasons for not following through with delayed reconstruction included poor-timing (25%), indecision (17%), desired method of reconstruction not readily available at treating facility (10%), persistent obesity (8.3%), continued smoking (4%), and undocumented (35%). The study was underpowered; however, emerging trends in factors positively associated with follow-through with delayed reconstruction were: younger age, non- or ex-smoker, lower BMI, and low Charlson co-morbidity index.
Conclusion: Many women did not receive breast reconstruction despite expressing an interest in the procedure. Reasons were multi-factorial and consisted of both patient and provider-related factors. Documentation regarding decision-making for reconstruction was inconsistent. Further studies exploring barriers to reconstruction may have the potential to improve patient satisfaction following mastectomy.
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