Treatment considerations in postmastectomy reconstruction: their relative importance and relationship to patient satisfaction.

Although studies concerning motivation for and satisfaction with breast reconstruction after mastectomy have proliferated, little information is available concerning the relative importance of motivating factors and satisfaction with treatment choice in nonreconstructed and reconstructed mastectomy patients. We studied this by questioning 144 women in four groups: mastectomy patients who had reconstruction; mastectomy patients who did not have reconstruction; and two control groups composed of women who had not had any cancer or who had undergone hysterectomy for uterine cancer. This study was conducted just before the reports of alleged risks of silicone to the patients and reflects the opinions of patients without such bias. This study shows that, although women who opted for reconstruction reported greater concern about appearance than women who did not have reconstruction, both groups described concerns about surgical discomfort and possible complications. Also, women's concerns about appearance did not seem to fall solely into public (others' evaluations) or private (patients' own evaluation) domains. Rather, personal attitudes about appearance may affect interpersonal experiences. Finally, concerns about the possibility of recurrence may reduce patient satisfaction for some women who have reconstruction, so postsurgical education regarding cancer risk may be needed. Reconstructed and nonreconstructed mastectomy patients do not appear to differ in postoperative behaviors promoting personal health. This information, analyzed before the silicone controversy, may serve as a baseline for future research on the impact of the silicone crisis on women's perceptions regarding reconstruction.