title: The option of delayed reconstructive surgery following mastectomy for invasive breast cancer: why do so few patients embrace this offer?
abstract: BACKGROUND
  Only a minority of patients who had undergone mastectomy for invasive breast cancer (BC) chose the option for delayed breast reconstruction (BR). We hypothesized that this might partly be (a) due to a lack of information, or (b) because many women cope well with their altered body.
  
  
  METHODS
  A cross-sectional survey was completed by 101 early-stage BC survivors who had primary mastectomy. Twenty-six patients had delayed BR. The survey included measures to attitudes to BR and experiences/expectations about information related to BR.
  
  
  RESULTS
  The percentage of patients who was informed regarding BR was high (97%). For 39.5% such information was not considered important, neither before mastectomy, nor during follow-up; advanced age was an important factor for the disinterest in information (odds ratio 1.81; 95% CI: 1.04-3.16; p = 0.033). For women without BR, the perception that mastectomy caused a serious damage to their body image changed over time to perceiving the operation as an acceptable alteration of the body (-1.10; 95% CI, -1.52, -0.64; p < 0.001); this process was similar to that in patients who had BR (paired t-test: -2.12; 95% CI, -2.82, -1.41; p > 0.001). From 63 patients who reported no intention to have a BR in the future, 28 (44.4%) responded with answers that showed a high satisfaction with their mastectomies without BR; 30 patients (47.6%) reported reasons, which might potentially be dispelled by information by an experienced reconstructive surgeon.
  
  
  CONCLUSIONS
  We did not find any evidence that the low number of patients who chose delayed BR results from a lack of information regarding this procedure. The majority of patients overcome negative attitudes towards their mastectomy quickly and are uninterested in BR. Patients who are ambivalent must be identified; these women require particular attention and should receive intensive counseling.
authors.affiliation: University Hospital Basel (UHB), Breast center, Spitalstrasse 21, CH-4031 Basel, Switzerland.
authors.forename: A M
authors.initials: AM
authors.lastname: Lardi
authors.forename: M E
authors.initials: ME
authors.lastname: Myrick
authors.forename: M
authors.initials: M
authors.lastname: Haug
authors.forename: D J
authors.initials: DJ
authors.lastname: Schaefer
authors.forename: J
authors.initials: J
authors.lastname: Bitzer
authors.forename: U
authors.initials: U
authors.lastname: Simmen
authors.forename: U
authors.initials: U
authors.lastname: Güth
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001290:Attitude; D001828:Body Image; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000601:surgery; D015986:Confounding Factors, Epidemiologic; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data*; D015411:Mastectomy, Modified Radical / Q000009:adverse effects / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors