Patient perspectives on accepting immediate breast reconstruction treatment decisions: patient attitudes and preferences associated with breast reconstruction

Introduction

According to the SOMIP report, not all the hospitals under the Hospital Authority can perform immediate breast reconstruction operation. Having the option of immediate breast reconstruction for breast cancer patient is it consider as a privilege? However, when offered this option, patient may not take up the procedure. Therefore, exploring the patient attitudes and own preferences of life style can be a consideration affecting her own treatment decision.

Objectives

Retrospectively look into pretreatment life style and attitude of patient who had considered immediate breast reconstruction from 2016 to 2018.

Methodology

99 patients who had attended the “combined breast and plastic clinic” for assessment from 2016 to 2018 and records were reviewed. Their mean age was 48.5. 28.28% patients were ductal carcinoma in-situ and 66.67% were invasive carcinoma on diagnosis. Most of their education levels were secondary or above and most of them were middle social class. < 20% patients claimed they had friends who had breast reconstruction done or had used prosthesis after mastectomy. Most of our patients thought it was important to let all the breast cancer patients knew about breast reconstruction. However, 24% patients claimed even knowing about breast reconstruction information did not relieve the traumatic psychological morbidities of having breast cancer. Nearly 20% of patients afraid having breast reconstruction might block or blur the breast cancer monitoring and increase chance of recurrence in the future.

Results & Outcome

The records of breast cancer patients who had the choice of immediate breast reconstruction from 2016 to 2018 were reviewed. Every patient before attending the “combined breast and plastic clinic” for assessment was invited to fill a questionnaire about patient’s attitude and own preference on her daily activities. The focus of this retrospective review is to identify the concern that may influence the decision of immediate breast reconstruction. The results suggested there are psychological burden related to cosmetic outcomes, post-operative complications and surveillance. In our centre, only around 12% newly diagnosed breast cancer patients would have interested in discussion on immediate breast reconstruction and eventually, 2/3 of patients chose immediate breast reconstruction. Shared decision making and good information transfer were our strategies to facilitate patients with more confidence in clinical decisions.