Breast reconstruction in bilateral prophylactic mastectomy patients: factors that influence decision making.
BACKGROUND
Utilization of bilateral prophylactic mastectomy (BPM) and reconstruction has increased secondary to numerous medical advances. The purpose of this study was to examine decision making in women electing this therapy to further understand what influences and drives this decision.


METHODS
The authors conducted a survey study, enrolling patients who elected BPM and reconstruction. Participants were mailed structured questionnaires utilizing validated and study specific tools addressing: demographics, treatment decisions, autonomy, decision making and information seeking preferences, and breast cancer treatment knowledge. Analysis was performed overall and by reconstruction.


RESULTS
40 patients responded (20 autologous, 19 implant and 1 combination, 66% response rate). The cohort was well educated and wealthy. Reconstructive options played a large role in the consideration of BPM. Patients were influenced by their physicians and less so by non-traditional means (media, internet, etc). Autologous reconstructions had a stronger desire to utilize their own tissue (p < 0.001) and were less concerned with the amount of surgery (0.02) and resulting scars (p = 0.01). Implant reconstructions more often stated that they did not have enough tissue for autologous reconstruction (p < 0.001) and did have a lower BMI, 24.2 vs. 27.5 (p = 0.03). Additionally, they were more influenced by non-traditional means (p < 0.001) and by other patients (p = 0.02).


CONCLUSIONS
Multiple factors influence decision making in BPM and reconstruction, with the ultimate choice in reconstruction involving tissue availability, appearance of implant reconstructions, total amount of surgery required, and extent of visible scars. Patients were strongly influenced by their physicians, and less so by non-traditional means.
Division of Plastic Surgery, Perelman School of Medicine at University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Jonas A
JA
Nelson
Julia
J
Tchou
Susan
S
Domchek
Seema S
SS
Sonnad
Joseph M
JM
Serletti
Liza C
LC
Wu
D000328:Adult; D000368:Aged; D018427:Breast Implants; D016009:Chi-Square Distribution; D003657:Decision Making; D003710:Demography; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D010414:Pennsylvania; D010817:Physician-Patient Relations; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous