Patient expectations impact satisfaction after implant-based breast reconstruction
Andrew L. Weinstein, M.D., M.S.1, Allison D. Glass, B.S.2, Andrea L. Pusic, M.D., M.H.S.3, Colleen M. McCarthy, M.D., M.P.H.2.
1New York - Presbyterian Hospital, New York, NY, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3Brigham and Women's Hospital, Boston, MA, USA.
Background: The purpose of this study was to evaluate the relationship between patient expectations and satisfaction after implant-based breast reconstruction using patient-reported outcomes.
Methods: A prospective cohort study was conducted on patients who underwent two-stage implant-based breast reconstruction between December 2014 and May 2018 at Memorial Sloan Kettering Cancer Center. Patients completed the expectations module of the BREAST-Q preoperatively and the postmastectomy reconstruction module at 6 months postoperatively. The domains evaluated using the BREAST-Q were psychosocial well-being, physical well-being, sexual well-being, satisfaction with breasts, and satisfaction with the medical team. The relationship between expectations and satisfaction was evaluated via Pearson correlation.
Results: 296 patients were enrolled during the study period. The average patient expectation score was 86.8±19.2 for psychosocial well-being, 76.1±17.2 for physical well-being, 72.2±26.8 for sexual well-being, 87.9±19.0 for satisfaction with breasts, and 75.5±22.7 for satisfaction with the medical team. At 6 months following the first-stage reconstruction with tissue expanders, patient expectations were negatively associated with physical well-being (r=-0.26, p=0.010). At 6 months following second-stage reconstruction with silicone implants, patient expectations were positively associated with psychosocial (r=0.34, p=0.011) and sexual (r=0.46, p=0.005) well-being, but not with physical well-being (r=0.08, p=0.566) or satisfaction with breasts (r=0.06, p=0.647).
Conclusions: Preoperative expectations significantly impact postoperative satisfaction among patients undergoing implant-based breast reconstruction, and differently for different BREAST-Q domains. The results of this study may therefore be used to better inform expectations and improve the shared medical decision-making process between patients and surgeons.
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