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Updated: Jul 7, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Are Expectations in Breast Reconstruction Manageable? A Mixed-Methods GoBreast II Study on Women's Goals of Breast
Anna Paganini1, Susanne Ahlstedt Karlsson1, Linda Myrin Westesson2
1Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Diagnostics, Acute, and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden.
Introduction:
Breast reconstruction aims to improve quality of life after mastectomy, but women's underlying goals vary widely and are often complex. Limited research has explored how these goals differ according to indication for mastectomy, timing of reconstruction, or reconstructive technique. Understanding patients' goals is essential for shared decision-making, managing expectations, and improving patient satisfaction.
Methods:
This cross-sectional mixed-methods study included women undergoing breast reconstruction within the preference arm of the GoBreast II trial at a Swedish university hospital. Participants completed a preoperative PEGASUS (Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) consultation to identify individual goals. Goals were analyzed using inductive qualitative content analysis and quantified by category frequency. Comparisons were made between reconstructive technique (autologous vs. implant-based), timing (immediate vs. delayed), and indication for mastectomy (therapeutic vs. risk-reducing).
Results:
Eighty-nine women were included (median age 48 years). Five main goal categories were identified: Achieving a feeling, just wanting the breast back, Aesthetic wishes, Practical matters, and the process. Women opting for implant-based reconstruction expressed more aesthetic goals than those choosing autologous reconstruction. Patients undergoing delayed reconstruction reported more goals related to practical matters. Women undergoing risk-reducing mastectomy expressed more aesthetic wishes and fewer practical concerns than women treated for breast cancer.
Conclusions:
Women's goals for breast reconstruction extend beyond physical restoration and include emotional, identity-related, and aesthetic dimensions. Structured identification of patient goals may improve preoperative counselling, shared decision-making, and management of expectations in breast reconstruction.
