Another study examined how women’s expectations around reconstruction change over time.
The review identified the need for consistent methods to capture and measure patient-reported expectations and outcomes. Five studies, which quantified expectations and whether expectations were met, discovered a positive correlation between meeting expectations and satisfaction with outcomes. These studies used a variety of qualitative, quantitative, and mixed methods to assess patients’ expectations of breast reconstruction outcomes. (2017) conducted a review of 20 studies that researched breast reconstruction patients’ expectations from 1994 to 2017. Several studies have researched how patient expectations impact satisfaction with breast reconstruction outcomes and quality of life. Knowledge about the importance of patients achieving their breast reconstruction expectations and preferences may inform psychosocial care of breast cancer patients. For example, a patient may prefer that she maintain her pre-surgery breast size but expect her breast size to change due to limitations of the reconstructive process. Patients’ expectations and preferences are distinct and may have different impacts on the psychosocial benefits of reconstruction. Patients’ preferences for how their body will look like after surgery are formed by each patient’s individual experience with their body and psychological well-being, separate from their preferences regarding treatment type. (1984) define patient expectations as “anticipations that given events are likely to occur” and desires, or preferences, as “a perception that a given event is wanted.” Patients’ expectations of their surgical outcomes are often formed by information they’ve gathered about breast reconstruction from their providers, social contacts, etc., as well as their intuition. Each patient has unique expectations and preferences for their surgical and aesthetic outcomes. The purpose of breast reconstruction is to recreate the look of breast mounds when clothed. This study provides preliminary evidence for a “Goldilocks principle” in women’s preferences for breast size change in the context of breast reconstruction, and identifies hypotheses for future studies of the associations among preference for change in breast size, preference achievement, and post-reconstruction body image. Multinomial logistic regression models found average breast volume and satisfaction with breast size to be the most important factors associated with preferences for changing or maintaining breast size for women undergoing breast reconstruction. Women with the smallest and largest 20% of baseline breast size were more likely to desire a change toward the mean ( p = 0.006). At baseline, mean average breast volumes were 755.7 ± 328.4 mL for all women ( n = 48), 492.3 mL ± 209.3 for 13 women who preferred to be “bigger than now,” 799.2 mL ± 320.9 for 25 women who preferred to remain “about the same,” and 989.3 mL ± 253.1 for 10 women who preferred “smaller than now.” Among the 23 women who preferred to change their breast size, 19 desired to shift toward the mean. The average age of participants was 45.7 ± 9.1 years. The goal of this study was to identify factors associated with preferences for changing or maintaining breast size for women undergoing breast reconstruction at The University of Texas MD Anderson Cancer Center in the United States from 2011 to 2014. Patients’ preferences regarding changing or maintaining their breast size after mastectomy and reconstruction are important but understudied determinants of post-surgical satisfaction and quality of life.
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