Abstract
Patients’ preferences regarding changing or maintaining their breast size after mastectomy and reconstruction are important but understudied determinants of post-surgical satisfaction and quality of life. The goal of this study was to identify factors associated with preferences for changing or maintaining breast size for women undergoing breast reconstruction at The University of Texas MD Anderson Cancer Center in the United States from 2011 to 2014. The average age of participants was 45.7 ± 9.1 years. At baseline, mean average breast volumes were 755.7 ± 328.4 mL for all women (n = 48), 492.3 mL ± 209.3 for 13 women who preferred to be “bigger than now,” 799.2 mL ± 320.9 for 25 women who preferred to remain “about the same,” and 989.3 mL ± 253.1 for 10 women who preferred “smaller than now.” Among the 23 women who preferred to change their breast size, 19 desired to shift toward the mean. Women with the smallest and largest 20% of baseline breast size were more likely to desire a change toward the mean (p = 0.006). Multinomial logistic regression models found average breast volume and satisfaction with breast size to be the most important factors associated with preferences for changing or maintaining breast size for women undergoing breast reconstruction. This study provides preliminary evidence for a “Goldilocks principle” in women’s preferences for breast size change in the context of breast reconstruction, and identifies hypotheses for future studies of the associations among preference for change in breast size, preference achievement, and post-reconstruction body image.
Highlights
The purpose of breast reconstruction is to recreate the look of breast mounds when clothed
Participants responded to the Brief Symptom Inventory-18 (BSI-18) (Derogatis, 2000), Appearance Schemas Inventory – Revised (ASI-R) (Cash et al, 2004), Body Image Scale (Hopwood et al, 2001), and BREAST-Q Reconstruction modules (Pusic et al, 2009), which assess levels of psychological distress, investment in their appearance, body image concerns, and satisfaction with breast reconstruction, respectively
We investigated pre-operative age, body mass index (BMI), relationship status, average breast volume, average ptosis, satisfaction with breast size (1–5 scale with 5 being most satisfied), satisfaction with current weight (1–5 scale with 5 being most satisfied), ASI-R composite score, BSI global score, BREAST-Q satisfaction with breasts (SWB) module, and BREAST-Q psychosocial well-being (PSWB) module as covariates that may be associated with breast size preference
Summary
The purpose of breast reconstruction is to recreate the look of breast mounds when clothed. Each patient has unique expectations and preferences for their surgical and aesthetic outcomes. Uhlmann et al (1984) define patient expectations as “anticipations that given events are likely to occur” and desires, or preferences, as “a perception that a given event is wanted.”. Patients’ expectations of their surgical outcomes are often formed by information they’ve gathered about breast reconstruction. Patients’ expectations and preferences are distinct and may have different impacts on the psychosocial benefits of reconstruction. A patient may prefer that she maintain her pre-surgery breast size but expect her breast size to change due to limitations of the reconstructive process. Knowledge about the importance of patients achieving their breast reconstruction expectations and preferences may inform psychosocial care of breast cancer patients
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