title: A retrospective investigation of women's experience with breast reconstruction after mastectomy.
abstract: OBJECTIVE
  A diagnosis of breast cancer is often accompanied by the fear of loss of previous body image and attractiveness. Hence, many patients opt for reconstructive surgery. This study evaluated the effects of different types of reconstructive surgery after mastectomy on the functional and psychological adjustment of patients.
  
  
  METHODS
  In a cohort study, patients, who had breast reconstruction after mastectomy by means of four different allogenic or autologues techniques between 1999-2006 were retrospectively interviewed in person or by telephone. The questions addressed complication rates, physical complaints, functional impairments, body image outcomes, sexuality and patient satisfaction.
  
  
  RESULTS
  Of 139 patients, 89 (64.7 %) completed the survey. 32 (35.9 %) patients experienced one or more postoperative complications like seroma, hematoma, infections or necrosis. 16 (20 %) and 13 (16 %) patients reported strong and moderate adverse effects on sexuality, respectively. 62 (70 %) patients indicated that they were actively included in the decision making process. Patient ratings of good or bad medical advice were associated with complication rates (p = 0.008). Patients, who evaluated their first preoperative counseling positively, reported higher consent rates when a re-reconstruction became necessary (p ≤ 0.001). Satisfaction with the functional outcome after reconstruction and satisfaction with the cosmetic result was highly correlated (p < 0.001).
  
  
  CONCLUSIONS
  A significant association of patient satisfaction with postoperative complications and the decision for a re-reconstruction was demonstrated. Furthermore, our results emphasize the importance of detailed preoperative counseling for women's adjustment to reconstructive surgery.
authors.affiliation: Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany. nina.ditsch@googlemail.com
authors.forename: Nina
authors.initials: N
authors.lastname: Ditsch
authors.forename: Ingo
authors.initials: I
authors.lastname: Bauerfeind
authors.forename: Andrea
authors.initials: A
authors.lastname: Vodermaier
authors.forename: Christina
authors.initials: C
authors.lastname: Tripp
authors.forename: Bettina
authors.initials: B
authors.lastname: Löhrs
authors.forename: Bettina
authors.initials: B
authors.lastname: Toth
authors.forename: Isabelle
authors.initials: I
authors.lastname: Himsl
authors.forename: Monika
authors.initials: M
authors.lastname: Graeser
authors.forename: Nadia
authors.initials: N
authors.lastname: Harbeck
authors.forename: Miriam
authors.initials: M
authors.lastname: Lenhard
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image / Q000523:psychology*; D019928:Breast Implantation / Q000379:methods / Q000523:psychology; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013524:Surgical Flaps