Awareness and Acceptability of Breast Reconstruction Among Women With Breast Cancer: A Prospective Survey

PURPOSE Quality of life has become an integral aspect of the management of breast cancer. Many women still need to undergo a modified radical mastectomy (MRM). Factors affecting the choice a woman makes to undergo breast reconstruction (BR) are unclear and are hypothesized to be influenced by socioeconomic factors. We conducted a survey to evaluate the awareness and acceptability of BR among women with breast cancer at our institution. METHODS A novel questionnaire was designed and served to 3 groups of women: planned for MRM, follow up (FU) post-MRM, and FU post breast-conserving surgery. RESULTS Responses were analyzed from 492 women. Of these, 280 (56.91%) were planned for MRM and 212 (43.08%) women were on FU. Almost 45% women were older than 50 years of age, and literacy rate was 87.6%. More than 70% were homemakers and 15 women (3%) were unmarried. The aspects evaluating awareness of BR suggested that 251 (51.01%) women had knowledge about BR. Major source of information was the surgeon (45.81%) and media (32.87%). About 80% women on FU post-MRM did not want reconstruction, and 55% did not opt for BR as they had coped with the mastectomy and did not feel the need for BR. Only 6% cited family or financial reasons and 10% cited recurrence concerns. Among women planned for surgery, 65.71% had not considered BR. When questioned, 25 (12.88%) felt influenced by cost, 102 (52.58%) felt they did not need it, and 20 (10.31%) were worried it would affect treatment. CONCLUSION Our study shows high awareness regarding BR, but only 27.89% women opt for BR independent of economic issues. We recommend all patients should be counseled about the reconstructive options when their MRM is planned.

Satisfaction with Life and Social Factors in Decision-Making Proces on Breast Reconstruction in Women after Mastectomy

Abstractwas to analyse the correlation between satisfaction with life in women after mastectomy and motivation to undergo breast reconstruction, compared to women who after breast amputation did not decide to undergo reconstructive treatment.Comparative analysis comprised patients after mastectomy, who decided on breast reconstruction (40) and those who did not undergo reconstructive surgery (40). The study was conducted in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz and Department of Oncological surgery and Breast Diseases ICZMP, Łódź, between 2013-2015. In the study the question whether higher satisfaction with life prompts decision on breast reconstruction was investigated. The Satisfaction with Life Scale (SWLS) was used, as well as an original questionnaire. The correlations between statistical parameters were evaluated using the chi-square test.We have demonstrated differences between the level of satisfaction with life in patients who decided to undergo breast reconstruction and those who did not choose reconstructive surgery. The discrepancies may reflect differences in the system of values and level of satisfaction with life before reconstructive treatment and also point to potential effect of these factors on the decision to undergo surgery.1. Differences in cognitive structures between ‘Amazons’ determine the decision on reconstructive treatment. 2. Transfer of information between the therapeutic team and women after mastectomy is not satisfactory. 3. Higher level of satisfaction with life has a positive effect on the decision of breast reconstruction.

Personality Traits and Decision on Breast Reconstruction in Women after Mastectomy

The aim of the study was evaluation of the correlation between selected personality traits in women after mastectomy and their decision on breast reconstruction.Material and methods. The study was conducted between 2013‑2015, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, and Department of Oncological and Breast Surgery, CZMP. Comparative analysis comprised 40 patients, in whom mastectomy and breast reconstruction was done, and 40 women after breast amputation, who did not undergo reconstructive surgery. Basing on self-constructed questionnaire, five features of personality were evaluated in these women: pursue of success in life, ability to motivate others, openness to other people, impact of belonging to a social group on sense of security and the importance of opinion of others about the respondent. Apart from the questionnaire, in both groups of women a psychologic tool was used (SUPIN S30 and C30 tests) to determine the intensity of positive and negative emotions.Results. Women who did not choose the reconstructive option were statistically significantly older at mastectomy than women who underwent breast reconstruction. There were statistically significant differences between both groups in response to question on being open to other people and value of other people’s opinion. The differences in responses to question on the impact of belonging to a social group on personal sense of safety were hardly statistically significant. In psychometric studies there were significant differences in responses to SUPIN C30 test for negative emotions and S-30 for positive emotions. The level of negative emotions - feature of group A was in 47.5% in the range of high scores and in 47.5% within low and low-average scores. Among women from group B 57.5% had high scores, while 37.5% low and average scores. There were significant differences in the results of positive emotions evaluation in S-30. Women who did not undergo breast reconstruction usually had high scores, while those who decided on reconstructive surgery usually had low scores and low-high scores.Conclusions. 1. The decision on breast reconstruction after mastectomy is connected with personality features of patients. Introvert women, who base their self-opinion on opinion of others and their sense of security on belonging to a social group, rarely choose to undergo breast reconstruction. 2. Younger patients after mastectomy more frequently choose the breast reconstructive option. 3. A special algorithm of medical and psychological care in patients after mastectomy should be created to improve their further quality of life.

Risk factors and management of breast cancer-related lymphedema

<p><strong>Background:</strong> Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life.</p><p><strong>Objective:</strong> The aim of this study was to identify the clinical presentation of lymphedema associated factors in women treated for breast cancer.</p><p><strong>Methods:</strong>The study is an interventional prospective study. It was accomplished in the period from May 2013 to April 2014. Patients having breast cancer ipsilateral arm lymphedema were selected for the study.</p><p><strong>Results:</strong> A total of 34 patients were included in the study.73.5% of patients have a body mass index (BMI) of 25 or more at diagnosis. 70.6% of the patients underwent axillary clearance. All the patients did not undergo breast reconstruction. 52.4% had &lt;10 lymph nodes removed from their axillae. 47% received radiotherapy. All patients presented with arm swelling, additionally, 70.6 % presented with arm heaviness 26.5% presented with arm pain. Elevation was effective in 90.5% of the compliant patients, while exercise was effective in 84.2% of the compliant patients.</p><p><strong>Conclusion:</strong> Breast cancer- related lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection axillary radiation should be avoided whenever feasible to avoid lymphedema.</p>

Social-cognitive variables as predictors of intention to undergo breast reconstruction

The aim of the study was to determine the role of self-efficacy, outcome expectancies, and risk perception (including consequences of mastectomy) in formulating the intention to undergo breast reconstruction in 178 women after total mastectomy. The social-cognitive variables were measured in the context of breast reconstruction, while depression was assessed using the Beck Depression Inventory. The structural equation modeling revealed that among the predictors there were only two that accounted for the intention to undergo breast reconstruction, i.e. self-efficacy and outcome expectancies (R2 = .67). Subsequent analyses of the related moderators, i.e. depression, age, and duration of the disease indicated a good fit to the data. Nevertheless, in subgroups with poorer resources (older age, depression, and longer duration of the disease) the direct effects of self-efficacy on intention were less noticeable or non-existent. The results suggest that self-efficacy may play the regulating role in making a breast reconstruction decision if individual resources are taken into account.

The relationship between general and specific self-efficacy during the decision-making process considering treatment

The aim of the study was to confirm the mediation effects of the task-specific self-efficacy on the relationship between the general self-efficacy and intention and planning considering treatment. The study comprised 265 subjects, of which 165 were post-mastectomy women and 100 patients hospitalized due to acute coronary syndrome (ACS). The variables were assessed using the Generalized Self-Efficacy Scale (GSES) and tools developed to examine the context of treatment. The data were analyzed using the bootstrapping procedure. The results confirmed the indirect effects of task-specific self-efficacy, both in women making a decision to undergo breast reconstruction, and in patients after ACS formulating intention to change risk behaviours. As smoking was considered to be a moderator in the post-ACS group, the obtained associations were observed only among the patients declaring quitting smoking. In view of the fact that taskspecific self-efficacy is susceptible to context (e.g. it may depend on quitting smoking), it is useful to assess it in order to increase treatment effectiveness.