title: A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma.
abstract: Breast shape may be retained after surgery for breast cancer with either wide local excision (WLE) and radiotherapy or mastectomy (M) and immediate reconstruction (M+R). We determined the proportions of patients who would be suitable for these options, would accept them, and if they declined M+R their reasons for doing so. Over a 10-month period 177 women were assessed at a combined breast clinic by general and plastic surgeons and by radiation oncologists. A prospective record was made of the patient demographic data, the clinical decisions (and their reasons), and the patient choices (and their reasons). A transverse rectus abdominis myocutaneous flap was the commonest method of reconstruction. One hundred thirty-five (76%) were judged to be suitable for locoregional surgery. Of these M+R was offered to 83 patients, whereas 53 were not considered because of combinations of cosmetic considerations (31), risk factors (25), old age (13), and oncological factors (nine). Fifty-one of the 83 (61%) offered M+R declined it because they preferred a simpler procedure (34), regarded breast appearance as unimportant (15), preferred breast conservation (five), did not have a partner (three), felt that they were too old (two), or had religious reasons (two). Ultimately 69 (51%) underwent M, 34 (25%) WLE, and 32 (24%) M+R. There was no correlation between acceptance or not of M+R and age, race, employment, education level, or marital status. We conclude that many patients were suitable for M+R, but fewer than half accepted it; this decision was unrelated to age, race, employment, or marital status.
authors.affiliation: Department of Surgery, Groote Schuur Hospital and University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Panieri
authors.forename: Dirk
authors.initials: D
authors.lastname: Lazarus
authors.forename: David M
authors.initials: DM
authors.lastname: Dent
authors.forename: Don A
authors.initials: DA
authors.lastname: Hudson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
authors.forename: I Dudley
authors.initials: ID
authors.lastname: Werner
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D002755:Choice Behavior; D015897:Comorbidity; D003376:Counseling; D004522:Educational Status; D004651:Employment; D004954:Esthetics; D005006:Ethnicity; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data*; D017533:Marital Status; D008408:Mastectomy; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa; D013524:Surgical Flaps