Patient motivations for choosing postmastectomy breast reconstruction

The number of women who undergo postmastectomy breast reconstruction is reported to be around 40% and, although increased from previous decades, seems lower than expected. The purpose of this report is to investigate and improve our understanding of women's motivations for choosing reconstruction.

We prospectively surveyed consecutive patients referred for possible reconstructive surgery at Emory University Hospital between December 2008 and September 2010. A Likert-scale (1-5) questionnaire was used evaluating body image, femininity and sexuality, and influences regarding reconstruction. Demographic information was collected and analyzed. A PubMed search was also performed evaluating national rates of reconstruction, the demographic disparities, and the decision-making process behind undergoing reconstruction.

Among the 155 women surveyed, most (63%, n = 99) were 40 to 60 years old, 54.8% (n = 85) were African American, and 41.3% (n = 64) were white. Overall, patients agreed more strongly with questions related to body image as a motivating factor for breast reconstruction than they did with questions related to sexuality or femininity (mean score, 2.85 vs 3.26). When asked about their primary motivation for breast reconstruction, 76% of women agreed it was to maintain a balanced appearance, 34% agreed it was to continue to feel feminine, and 7.7% agreed it was to maintain sexual functioning. When asked about outside influences in pursuing breast reconstruction, the 51.6% of patients reported that they were urged by their referring physician to consider it, and most of the patients (58%) discussed the surgery with other breast cancer patients considering breast reconstruction.

Women pursuing breast reconstruction are motivated more by concerns of body image than issues of sexuality or femininity, which is independent of any demographic characteristics. It is important for referring physicians to recognize their role in initiating the discussion on reconstruction, and women would benefit from being referred to support groups to discuss their treatment and reconstruction with other breast cancer patients.