"Best for Me": Decision-Making and Medical System Interactions When Going Flat After Bilateral Mastectomy

Area of Science:

• Oncology
• Surgical Oncology
• Patient-Centered Care

Background:

• Increasing numbers of young breast cancer survivors seek surgical information post-mastectomy.
• Focus on survivors choosing aesthetic flat closure (AFC) after bilateral mastectomy.

Purpose of the Study:

• To explore decision-making factors for young survivors opting for AFC.
• To understand interactions with the cancer care system for these survivors.

Main Methods:

• Semi-structured interviews with 18 US breast cancer survivors (diagnosed <45 years) who underwent AFC.
• Interpretative Phenomenological Analysis of interview transcripts.

Main Results:

• Eight themes emerged regarding decision-influencing factors: self/partner perspectives, functionality, recovery, safety, body image, and role modeling.
• Survivors often advocated for AFC, encountering assumptions of reconstruction and system-level issues like infantilization.
• Positive themes included gender-affirming surgery advancements and supportive provider communication.

Conclusions:

• Young survivors prioritize functionality, autonomy, and gender expression over conventional aesthetics.
• Survivors frequently needed to self-advocate for AFC.
• Healthcare providers should offer a full spectrum of affirming and accessible post-mastectomy surgical options, including AFC, to promote bodily autonomy.