title: Breast Reconstruction Post Mastectomy: Patient Satisfaction and Decision Making.
abstract: BACKGROUND
  Although breast reconstruction has been shown to improve psychological, physical, and sexual well-being, Australia still has one of the lowest reconstruction rates among well-developed countries. This study explores both the quality-of-life benefits of reconstruction and the factors that influence patients' decisions of whether or not to undergo reconstruction.
  
  
  METHODS
  This retrospective cohort study (296 consecutive mastectomy patients from 2000 to 2010) uses an internationally validated questionnaire (BREAST-Q) to evaluate patients' satisfaction with or without breast reconstruction. In addition, we analyzed factors that influence patients' decisions of whether to undergo reconstruction.
  
  
  RESULTS
  Two hundred nineteen patients responded (74%) and of the 143 patients who elected to participate, 79 were in the "reconstruction group" and 64 in the "no-reconstruction group" post mastectomy. Patient demographics and cancer variables of the 2 groups were matched with the exception of age (reconstruction group 9.7 years younger: P < 0.01). The reconstruction group showed statistically significantly higher BREAST-Q scores with regard to satisfaction with the breast (P < 0.0001), psychological well-being (P = 0.0068), and sexual well-being (P = 0.0001). For the reconstruction group, the main reasons for undergoing reconstruction included improved self-image, more clothing choices, and the feeling of overcoming the cancer. One third of non-reconstructed patients still feared that reconstruction would mask cancer recurrence.
  
  
  CONCLUSIONS
  Our study confirms the positive effects of breast reconstruction post mastectomy and identifies reasons that influence patients' decisions of whether to undergo reconstruction. Breast reconstruction should be seen as an integral part in the comprehensive care of women with breast cancer and an important health care priority in Australia.
authors.affiliation: From the *Departments of Plastic and Reconstructive Surgery and †Surgery, Peninsular Health, Victoria; and ‡Peninsula and Gippsland Clinical Schools, Monash University, Victoria, Australia.
authors.forename: Sally K
authors.initials: SK
authors.lastname: Ng
authors.forename: Rowena M
authors.initials: RM
authors.lastname: Hare
authors.forename: Ronny J
authors.initials: RJ
authors.lastname: Kuang
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Smith
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Brown
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter-Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003657:Decision Making; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies