title: Influential Forces in Breast Cancer Surgical Decision Making and the Impact on Body Image and Sexual Function.
abstract: Shared decision making with one's partner and body image satisfaction may affect surgical choices of breast cancer patients. This study analyzed whether partner opinion was associated with choice of operation and whether comfort level with one's partner was altered postoperatively.
  
  
  
  A prospective anonymous survey was administered to breast cancer patients who underwent breast surgery between 2000 and 2014. Categorical variables were compared by χ (2) or Fisher's exact test.
  
  
  
  Women who elected to undergo mastectomy with reconstruction (MR) placed greater emphasis on their own decision making than on input from their partner, surgeon, or others (56.5 vs. 8.3 vs. 23.2 vs. 12, respectively), whereas those who chose lumpectomy (L) placed similar weight on surgeon input and self-input (44.2 vs. 42.7 %). Only 7.5 % of all patients identified their partner as the greatest influence on their surgical choice. Preoperatively, the L group was the most comfortable with their partner seeing their chest (91.9 % L vs. 83.9 % MR vs. 75.9 % mastectomy alone (M); p = 0.01), and postoperatively, the comfort levels for all were remarkably decreased. Furthermore, if a patient was a candidate for L but chose MR, the role her chest played in intimacy dropped more compared with those who chose L (83.8 % L vs. 91.7 % MR; p = 0.3 preoperatively to 65.1 % L vs. 42.9 % MR; p = 0.01 postoperatively).
  
  
  
  When making surgical decisions, most patients indicate that they value their own opinion over that of others. Mastectomy, regardless of reconstruction, leads to a significant reduction in comfort with one's partner postoperatively compared with lumpectomy. This information may be helpful in counseling couples at the time of consultation for breast cancer treatment.
authors.affiliation: The Program in Women's Oncology, Women and Infants Hospital Breast Health Center, Warren Alpert School of Medicine/Brown University, Providence, RI, USA. rebeccamkwait@gmail.com.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Kwait
authors.affiliation: St. Peter's Health Partners Medical Associates, St. Peter's Hospital, Albany, NY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pesek
authors.affiliation: Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michaela
authors.initials: M
authors.lastname: Onstad
authors.affiliation: The Program in Women's Oncology, Women and Infants Hospital Breast Health Center, Warren Alpert School of Medicine/Brown University, Providence, RI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Edmonson
authors.affiliation: Center for Health Policy and Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
authors.affiliation: Division of Research, Women and Infants' Hospital of Rhode Island, Providence, RI, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Raker
authors.affiliation: The Program in Women's Oncology, Women and Infants Hospital Breast Health Center, Warren Alpert School of Medicine/Brown University, Providence, RI, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Stuckey
authors.affiliation: The Program in Women's Oncology, Women and Infants Hospital Breast Health Center, Warren Alpert School of Medicine/Brown University, Providence, RI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image; D001943:Breast Neoplasms / Q000601:surgery*; D002755:Choice Behavior; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D016462:Mammaplasty / Q000523:psychology; D008408:Mastectomy / Q000523:psychology*; D015412:Mastectomy, Segmental / Q000523:psychology; D008875:Middle Aged; D010358:Patient Participation; D010819:Physician's Role; D011446:Prospective Studies; D019529:Sexuality; D018454:Spouses / Q000523:psychology; D011795:Surveys and Questionnaires