title: Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer.
abstract: BACKGROUND
  Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR.
  
  
  METHODS
  Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy.
  
  
  RESULTS
  Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR.
  
  
  CONCLUSIONS
  Anticipated radiation therapy, higher age and higher BMI were important breast surgeon-related factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Mariska
authors.initials: M
authors.lastname: Weenk
authors.affiliation: Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wunschel
authors.affiliation: Department of Plastic Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Heine
authors.affiliation: Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Strobbe
keywords: Breast neoplasms; breast reconstruction; decision making; mammaplasty; mastectomy