title: Understanding the factors that influence breast reconstruction decision making in Australian women.
abstract: BACKGROUND
  Breast reconstruction is safe and improves quality of life. Despite this, many women do not undergo breast reconstruction and the reasons for this are poorly understood. This study aims to identify the factors that influence a woman's decision whether or not to have breast reconstruction and to better understand their attitudes toward reconstruction.
  
  
  METHODS
  An online survey was distributed to breast cancer patients from Breast Cancer Network Australia. Results were tabulated, described qualitatively and analyzed for significance using a multiple logistic regression model.
  
  
  RESULTS
  501 mastectomy patients completed surveys, of which 62% had undergone breast reconstruction. Factors that positively influenced likelihood of reconstruction included lower age, bilateral mastectomy, access to private hospitals, decreased home/work responsibilities, increased level of home support and early discussion of reconstructive options. Most common reasons for avoiding reconstruction included "I don't feel the need" and "I don't want more surgery". The most commonly sited sources of reconstruction information came from the breast surgeon followed by the plastic surgeon then the breast cancer nurse and the most influential of these was the plastic surgeon.
  
  
  CONCLUSIONS
  A model using factors easily obtained on clinical history can be used to understand likelihood of reconstruction. This knowledge may help identify barriers to reconstruction, ultimately improving the clinicians' ability to appropriately educate mastectomy patients and ensure effective decision making around breast reconstruction.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia. Electronic address: ron.somogyi@gmail.com.
authors.forename: Ron Barry
authors.initials: RB
authors.lastname: Somogyi
authors.affiliation: Division of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Webb
authors.affiliation: Cogentum Inc., Level 9, 45 William St, P.O. Box 50, Darling South, VIC 3145, Australia.
authors.forename: Nairy
authors.initials: N
authors.lastname: Baghdikian
authors.affiliation: Department of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Stephenson
authors.affiliation: Australian Catholic University and St Vincent's Private Hospital, Melbourne Nursing Research Unit, Faculty of Health Sciences, Australian Catholic University, Locked Bag 4115, MDC, Fitzroy, VIC 3065, Australia.
authors.forename: Karen-Leigh
authors.initials: KL
authors.lastname: Edward
authors.affiliation: The O'Brien Institute of Microsurgery, 42 Fitzroy St, Fitzroy, VIC 3065, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D001315:Australia; D001828:Body Image; D001943:Breast Neoplasms / Q000601:surgery*; D003657:Decision Making; D004651:Employment; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility; D016304:Hospitals, Private; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D036301:Qualitative Research
keywords: Barriers; Breast reconstruction; Decision making; Mastectomy