Preferences for Care among African American Women Considering Postmastectomy Breast Reconstruction

Approximately 20% of patients report inadequate discussions with their providers about reconstructive options, with an increased frequency reported by non-White women. Eliciting treatment preferences with adaptive choice-based conjoint (ACBC) analysis can improve understanding of what patients value. The authors aimed to determine what African American patients value when considering breast reconstruction options.

Cross-sectional ACBC analysis was performed for African American women considering breast reconstruction who were recruited through community partnerships and an academic medical center. Relative importance scores, part-worth utilities, and maximum-acceptable risks were calculated to assess preferences for attributes of flap versus implant reconstruction.

Overall, 181 women-101 from an academic center and 80 from the community-were included. The most important attributes were risk of complications (mean ± SD relative importance [RI], 26% ± 12%), additional operations (RI, 24% ± 14%), and abdominal morbidity (RI, 22% ± 11%). Women were least concerned with appearance (RI, 15% ± 12%) and recovery time (RI, 14% ± 10%). Fewer women preferred a profile representing flap ( n = 27 [15%]) compared with implant reconstruction ( n = 154 [85%]). Those who preferred flap reconstruction cared most about additional operations (RI, 36% ± 15%); in contrast, those who preferred implant reconstruction cared most about complications (RI, 27% ± 12%). Participants with fewer comorbidities (OR, 0.84; P = 0.012), no pervious surgical complications (OR, 0.32; P = 0.029), or prophylactic mastectomy (OR, 6.07; P = 0.19) were more likely to choose the implant profile.

African American patients place greatest value on minimizing complication risk and additional surgery when considering postmastectomy reconstruction. Future studies should assess how eliciting individual-level preferences can improve shared decision-making in surgery.