title: Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy.
abstract: BACKGROUND
  The aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction.
  
  
  METHODS
  We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients.
  
  
  RESULTS
  The proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction. For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients.
  
  
  CONCLUSIONS
  Better understanding the factors that influence decision of nonreconstruction can help us adapt the information to serve the patient's personal needs.
authors: Department of Surgery, Paris, France.
authors: Delphine
authors: D
authors: Héquet
authors: Kevin
authors: K
authors: Zarca
authors: Sylvie
authors: S
authors: Dolbeault
authors: Benoît
authors: B
authors: Couturaud
authors: Charlotte
authors: C
authors: Ngô
authors: Virgine
authors: V
authors: Fourchotte
authors: Anne
authors: A
authors: De La Rochefordière
authors: Jean-Guillaume
authors: JG
authors: Féron
authors: Alfred
authors: A
authors: Fitoussi
authors: Catherine
authors: C
authors: Bélichard
authors: Fabien
authors: F
authors: Reyal
authors: Fatima
authors: F
authors: Laki
authors: David
authors: D
authors: Hajage
authors: Brigitte
authors: B
authors: Sigal
authors: Bernard
authors: B
authors: Asselain
authors: Séverine
authors: S
authors: Alran
keywords: Breast cancer; Breast reconstruction; Mastectomy; Medical information; Personal choice
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