Patients' preferences for breast reconstruction: a discrete choice experiment

Patients' preferences are important determinants in the decision for a specific type of breast reconstruction (BR). Understanding their considerations in the decision for a specific type of BR can contribute to further improvement in patient counselling. We explored patients' preferences for three BR modalities in a discrete choice experiment (DCE).

We approached 386 patients who had previously undergone a therapeutic (n=309) or prophylactic (n=79) mastectomy, of whom 247 had also undergone a BR. These women were asked to choose between hypothetical BR profiles that were characterised by six treatment attributes: (1) material used for reconstruction, (2) number and duration of operations, (3) short-term complication rate, (4) long-term complication rate, (5) aesthetic result and (6) waiting time. The relative importance of attributes and trade-offs that the patients were willing to make among them were analysed using a multinomial logit regression model.

The overall response rate was 71%. All treatment characteristics proved important for patients to make their choices. Respondents generally expressed a preference for autologous material and an excellent aesthetic result, which had the biggest positive effect on preferences. Complication rates of 20-30% had a similar negative effect. In this DCE, autologous free flap BR fitted in best with patients' preferences.

Our study provides insight into the relative weight patients place on various aspects of BR and trade-offs they make among BR characteristics. In addition to understanding patients' considerations, professional assessment of the technical feasibility, acceptable risks and obtainable aesthetic result of different techniques will always remain crucial in deciding which technique is best suited for an individual patient.