Immediate or delayed breast reconstruction after mastectomy: what do women really want

Breast reconstruction, especially immediate reconstruction after mastectomy has increased over the last decades, at present being regularly offered in many centres worldwide. Despite obvious benefits and the evident oncological safety of primary breast reconstruction, the majority of women still receive a delayed procedure or even no reconstructive surgery. The objective of the present study was to determine the preference of women for breast reconstruction—immediate or delayed—and in the case of rejection of treatment to find out the reasons for this reluctance. In a prospective study a sample of 200 women—divided into two groups—were evaluated by an oral interview on the subject. The two-formed groups of participants consisted of randomly chosen women (n=100) and non-surgical nurses (n=100). The questionnaire surveyed personal data including marital status and educational level, as well as information about the preferred timing, the method of and the reasons for or against breast reconstruction. The evaluation of all data showed that 66% of the participants voted for additional surgery after mastectomy. Young age and high education level were significantly correlated (age r=0.56, P<0.01; education r=0.25, P<0.01) to the wish for reconstruction. The mean age of all participants was 39 years (range 20–69), with a significant difference between the two groups (P<0.01), the group of nurses being younger (mean age 35, range 20–62) and the other women being older (mean age 43, range 20–69). Concerning the timing of reconstruction, 21% of women elected to have an immediate and 27% a delayed operation. Yet, 52% could not come to a decision as to whether they should prefer a primary or secondary procedure. For the surgical procedure—autologous versus non-autologous tissue—about 23% of the participants could not decide spontaneously, while 40% preferred autologous tissue, 14% implants and 23% would choose a combination of both. The main reason in favour of reconstruction was that it would enhance the physical appearance (96%), whereas an important reason for general rejection was the fear of additional surgical risk (19%). For primary reconstruction, a high percentage of women also were highly concerned that reconstruction could mask cancer recurrence (62%). Although the majority of women—unaffected with breast cancer—are interested in breast reconstruction, more than half of them cannot decide spontaneously about the timing and mode of surgery, including the medical women. The collected data emphasize the urgent necessity to systematically inform women and the whole population about the options of breast reconstruction. Equally important is for the involved surgeons to know the individual wishes and fears of women unexpectedly confronted with the diagnosis of breast cancer in order to provide comprehensive preoperative counselling with respect to cancer therapy including breast reconstruction.