The Metamorphosis of Patient Priorities Throughout the Breast Reconstruction Process.

ABSTRACT

BACKGROUND: Breast reconstruction is a lengthy, multistage process guided by patients. It is vital to understand how their goals vary over time to achieve optimal outcomes. OBJECTIVES: This study aimed to evaluate how breast reconstruction patients' priorities changed throughout the reconstructive process. METHODS: Fifty women who underwent immediate breast reconstruction completed a quality of life survey at their preoperative appointment, 3, 6, and 12 months after surgery, and then again 10 years later. Scores on the survey's subsections corresponded to different patient priorities survival, restitution, symmetry, and enhancement. The relationship between time and survey-measured patient priorities was analyzed with mixed-effects regression models and Tukey's HSD (honestly significant difference) tests were performed to make pairwise comparisons between time points. RESULTS: Survival scores decreased between 3 and 12 months after surgery (P < .001) before returning to baseline at long-term follow-up. Restitution scores were decreased only at 12 months postoperatively (T3 vs T0, T1, and T2, P < .001; T3 vs T4, P = .003). Symmetry scores increased from preoperatively to 6 months postoperatively (P < .001), and then fell back to baseline by month 12 (P < .001) and remained at that level at long-term follow-up. Enhancement scores increased from preoperatively to 12 months after surgery (P < .001), before returning to baseline at 10-year follow-up (T0 vs T4, P > .99; T3 vs T4, P < .001). Time had an overall significant effect on each subsection score (P < .001), but this relationship was restricted to certain time points. CONCLUSIONS: In the year following immediate breast reconstruction, patients' concern over their physical health decreases while they become increasingly focused on enhancing the appearance of their reconstructed breasts. However, by 10 years after surgery, patients' priorities were virtually unchanged from their preoperative desires.