title: Delayed autologous breast reconstruction: factors which influence patient decision making.
abstract: BACKGROUND
  Autologous breast reconstruction timing continues to be controversial. The purpose of this study was to examine delayed autologous breast reconstruction at a center favouring immediate reconstruction to better understand factors driving the decision to delay reconstruction.
  
  
  METHODS
  We performed a retrospective cohort study of all free autologous breast reconstruction patients between 2005 and 2009, focussing on ethnicity, cancer stage, unilateral or bilateral reconstructions, initial management, distance from the institution, and average income. Delayed reconstructions were compared to immediate reconstructions. All delayed reconstructions were surveyed to examine treatment and reconstruction decisions and satisfaction.
  
  
  RESULTS
  Of 709 patients, 169 (24%) underwent delayed treatment. Delayed reconstruction patients had higher cancer stages (p < 0.001), higher rates of pre-reconstruction radiation therapy (64% vs. 20%, p < 0.0001) and higher rates of unilateral reconstruction (64% vs. 48%, p < 0.001). Seventy delayed patients responded to the survey (41%), with 75% having had their initial mastectomy at an outside health system. Only 51% discussed immediate reconstruction prior to electing delayed treatment and 41% had no discussion regarding advantages or disadvantages to reconstructive options. Approximately 30% noted no choice in their reconstructive timing. Forty five percent would elect immediate reconstruction if given the option.
  
  
  CONCLUSIONS
  This study demonstrates that women may not be receiving all available information prior to undergoing mastectomy for initial breast cancer treatment. As a significant portion of women electing delayed reconstruction would elect immediate autologous reconstruction if given the option again, there is room for improvement in pre-operative patient education and in the education of our oncology colleagues.
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States. Electronic address: jonas.nelson@uphs.upenn.edu.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: M Anne
authors.initials: MA
authors.lastname: Radecki
authors.forename: Christina
authors.initials: C
authors.lastname: Pasick
authors.forename: Jennifer
authors.initials: J
authors.lastname: McGrath
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003657:Decision Making; D019033:Delivery of Health Care, Integrated; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013997:Time Factors
keywords: Autologous; Breast reconstruction; Decision making; Delayed reconstruction; Free flap; Survey