Patient Choice: Autonomy and Ethics in Breast Reconstruction

Breasts hold multifaceted significance in modern society, encompassing elements of motherhood, sexuality, and female identity. Diseases of the breast can thus result in uniquely complex decision making, particularly in the case of malignancy when mastectomy is indicated. Patient narratives reveal the profound impact of breast loss on self-perception, femininity, and community belonging. Although post-mastectomy breast reconstruction is empirically well supported, intersecting societal pressures and surgeon biases may challenge the autonomy of patients deciding on reconstructive options.This article critically examines various factors involved in decision-making in breast reconstruction following mastectomy, highlighting the significance of patient autonomy. We excavate the historical, sociocultural, and economic influences that may have tilted the current balance in favor of breast reconstruction. While considering the benefits of this shift, we examine the potential existing biases that may influence patient decisions. We emphasize that autonomy is a central ethical consideration in navigating complex reconstructive decisions and promoting patient-centered care. We hope that our work will contribute to a broader discussion on the value placed on breasts and reinforce the agency breast cancer survivors have in decision making.