Aims: Many studies have demonstrated the positive impact of breast reconstruction (BR) on women’s quality of life following mastectomy for breast cancer. However, women’s preferences for BR are not always fully considered by surgeons prior to mastectomy. The aim of this research is three-fold: to document the negative impact lack of choice has had on some Australian women; to explore potential reasons for the absence of informed discussion; and to develop a checklist of discussion topics to aid informed decision-making.
Methods: As part of a broader study, semi-structured interviews with 22 women with breast cancer, 31 oncoplastic and plastic reconstructive breast surgeons and 37 health professionals (mainly breast care nurses – BCNs) were conducted by either by telephone or face-to-face, between May 2015-May 2017. This presentation focuses on responses from the 22 women who were purposively selected for participation based on their self-identified negative experiences with accessing information about BR options following mastectomy.
Results: Interviews revealed cases where BR was not offered prior to mastectomy, even though it was available locally; where BR was not available locally, but patients were not informed about BR options available in other locations; where only delayed BR options were discussed; and where the type of BR being offered did not align with patient preferences. Breast surgeons are the gate-keepers to facilitating the range of choices but too often appeared to limit access to reconstructive surgery.
Conclusion: A lack of BR information or choice at the time of mastectomy led to severe and enduring emotional distress in this select cohort of women. We have suggested essential BR referral pathways and discussion points to be raised with all clinically eligible women interested in considering BR. The challenge is how to translate these principles of informed decision making into policy and clinical practice. We discuss some possible methods.