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Updated: May 9, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
What Rankings, Ratings, and Utilities Do Breast Cancer Patients Place on Tissue- and Implant-based Breast
Haoqi Wang1,2, Nsikak M Jackson3, Danmeng Huang3
1From the Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas.
Background:
Utility analysis is well-established for comparing treatment options but challenging to assess with patients in clinical care. Preference assessment may be more feasible, but it is not yet known whether it correlates with utilities. The aims of this study were to (1) assess women's rankings, ratings, and utilities for tissue-based, implant-based, and no reconstruction after total mastectomy; and (2) explore assessment methods and correlations with clinical and psychosocial factors.
Methods:
Forty patients considering or undergoing breast reconstruction completed 3 assessments-card ranking, visual analog scale, and standard gamble-and psychosocial questionnaires. Each woman rated 9 health states with case-matched images: 4 excellent, good, fair, and poor outcomes for tissue-based reconstruction; 4 for implant-based reconstruction; and 1 image for no reconstruction. Nonparametric tests compared assessment methods. Descriptive statistics summarized rankings, ratings, and utilities. Multivariable regression models assessed correlations with clinical/psychosocial factors.
Results:
Median standard gamble utilities by category were 0.97 (excellent), 0.95 (good), 0.94 (fair), and 0.92 (poor) for tissue-based reconstruction; 0.99 (excellent), 0.96 (good), 0.94 (fair), and 0.94 (poor) for implant-based reconstruction; and 0.86 for no reconstruction. The standard gamble required 20-40 minutes, and some patients found it difficult. The visual analog scale required 5 minutes and correlated with the standard gamble. Psychosocial characteristics correlated with the scores; however, a more diverse sample is needed.
Conclusions:
All assessments showed that women highly value breast reconstruction after mastectomy. For time-limited clinical care, the visual analog scale is brief, understandable, and clearly illustrates preferences to support shared decision-making.
