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Patient Preferences for Postmastectomy Breast Reconstruction
Ronnie L Shammas1, Anna Hung2,3, Alexandria Mullikin1
1Division of Plastic, Maxillofacial and Oral Surgery, Duke University, Durham, North Carolina.
JAMA Surgery
|September 27, 2023
Summary
Women undergoing breast reconstruction prioritize minimizing risks like abdominal morbidity and complications. Preferences for flap versus implant reconstruction influence which factors, such as appearance or recovery, are most valued.
Area of Science:
- Plastic Surgery
- Patient-Reported Outcomes
- Decision Science
Background:
- Patient dissatisfaction after breast reconstruction is common, often stemming from outcomes misaligned with personal preferences.
- Understanding patient values is crucial for improving shared decision-making in surgical planning.
- Adaptive choice-based conjoint (ACBC) analysis offers a method to elicit individual treatment preferences.
Purpose of the Study:
- To identify key attributes influencing women's decisions regarding breast reconstruction.
- To compare attribute importance between patients preferring flap versus implant reconstruction techniques.
Main Methods:
- A web-based, cross-sectional study involving 406 women considering or with a history of breast reconstruction.
- Adaptive choice-based conjoint (ACBC) analysis was employed to assess patient preferences.
- Relative importance scores and utility values were calculated for various surgical attributes.
Main Results:
- The most critical attributes were risk of abdominal morbidity (28%), chance of major complications (25%), and number of additional operations (23%).
- Implant reconstruction preference was associated with higher prioritization of abdominal morbidity and complication risks.
- Flap reconstruction preference was linked to greater importance placed on additional operations and breast appearance.
Conclusions:
- This study highlights the significant impact of risk-related factors on patient choices in breast reconstruction.
- Patient preferences vary based on the chosen reconstruction method (flap vs. implant).
- Decision aids incorporating individual preferences can enhance patient-physician communication and promote patient-centered care.
