title: Why Some Mastectomy Patients Opt to Undergo Delayed Breast Reconstruction: Results of a Long-Term Prospective Study.
abstract: BACKGROUND
  Delayed breast reconstruction is an option for women who have undergone mastectomy; however, uptake is low. The purpose of this study was to identify premastectomy and postmastectomy demographic, clinical, and psychosocial predictors of uptake of delayed breast reconstruction in the long-term survivorship period.
  
  
  METHODS
  This was a prospective longitudinal survey study of mastectomy patients in which a repeated measures design was used to evaluate uptake of delayed breast reconstruction. Demographic, clinical, and psychosocial variables were collected before mastectomy and 1 year after mastectomy. Information regarding uptake of delayed breast reconstruction was collected at approximately 6 years after mastectomy. A predictive model was designed using a multivariate logistic regression model and Akiake information criterion stepwise algorithm.
  
  
  RESULTS
  Ninety-six mastectomy patients were followed from before mastectomy to 75.2 months after mastectomy, and 35 women (36.5 percent) underwent delayed breast reconstruction. Women who elected for delayed breast reconstruction experienced worsening of body concerns from before mastectomy to 1 year after mastectomy, compared with women who did not elect to undergo delayed breast reconstruction (p = 0.03). Mean scores for psychological distress were significantly worse both before mastectomy and 1 year after mastectomy in women who went on to undergo delayed breast reconstruction compared with those who did not undergo delayed breast reconstruction (p = 0.034 and p = 0.022, respectively). A predictive model for the uptake of delayed breast reconstruction was developed using demographic, clinical, and psychosocial characteristics. The area under the receiver operating characteristic curve was 85 percent, indicating good precision.
  
  
  CONCLUSIONS
  Women who are experiencing higher levels of distress, anxiety, and body concerns both before and after mastectomy appear to be significantly likely to select delayed breast reconstruction. This may have implications for postreconstruction satisfaction and psychosocial functioning.
  
  
  METHODS
  Risk, III.
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Metcalfe
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: John
authors.initials: J
authors.lastname: Semple
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: May-Lynn
authors.initials: ML
authors.lastname: Quan
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Claire
authors.initials: C
authors.lastname: Holloway
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Frances
authors.initials: F
authors.lastname: Wright
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Steven
authors.initials: S
authors.lastname: Narod
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Bagher
authors.affiliation: Toronto, Ontario, and Calgary, Alberta, Canada.|From the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's College Research Institute; Sunnybrook Regional Cancer Centre; University Health Network; and Foothills Medical Centre.
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000523:psychology; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D057240:Patient Preference; D011446:Prospective Studies; D057566:Self Report; D013997:Time Factors