How patients evaluate breast reconstruction after mastectomy, and why their evaluation often differs from that of their clinicians.

INTRODUCTION: The evaluation of breast reconstruction after treatment for cancer sometimes differs between the patient who receives it and the surgeon who performs it. Questionnaire studies shed little light on this. We therefore aimed to discover what factors influence how patients evaluate breast reconstruction and thereby to understand sources of disagreement between practitioners and patients in their evaluation.
METHODS: At the study centre, patients who undergo reconstruction following breast cancer rate their subjective evaluation of the procedure, and the surgeon and breast care nurse jointly rate their assessment of cosmesis. We interviewed in depth 27 patients with a range of scores on each rating to elicit the reasons for their evaluations. Interviews were analysed qualitatively with particular attention to patients whose evaluations diverged from those of practitioners.
RESULTS: Influences on patients' subjective evaluations included two aspects of cosmesis (how 'normal' they felt and how normal or attractive they thought they appeared to others), but also how much they trusted and respected their practitioners and felt cared for by them, whether reconstruction had helped to complete their 'cancer journey' and post-operative complications.
CONCLUSION: Patients' subjective evaluation of reconstruction after cancer treatment extends well beyond cosmesis, and experience of cancer influences what they consider important. Evaluations therefore often differ from those of practitioners. Surgeons and specialist nurses need to be aware of the factors that influence patients' evaluations in order to guide patients appropriately in decisions about surgery, and to evaluate outcomes across the domains that matter to patients.