Factors associated with the desire to undergo post-mastectomy breast reconstruction in a Mexican breast cancer center.

PURPOSE: To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. METHODS: Women with stage I-III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. RESULTS: A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. CONCLUSIONS: Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.

Propiedades Psicométricas del Cuestionario de Motivos a Favor y en Contra de la Reconstrucción Mamaria / Psychometric Properties of the Questionnaire of Motives for and against Breast Reconstruction

Antecedentes: Aunque la reconstrucción mamaria (RM) tras la mastectomía es una opción estética con buenos resultados, se realiza poco en México. Para estudiar sus razones se creó el Cuestionario de Motivos a favor y en contra de la Reconstrucción Mamaria (CMRM). La de validez de contenido del CMRM ha sido comprobada, pero no otras propiedades psicométricas. Objetivos: determinar su estructura factorial y comprobar su fiabilidad y validez de constructo concurrente. Método: Este estudio instrumental con diseño no experimental de corte transversal usó un muestreo intencional. Se aplicó el CMRM integrado por dos escalas, un cuestionario de imagen corporal y preguntas sobre datos sociodemográficos, clínicos y conducta sexual a 110 mujeres mexicanas mastectomizadas. Resultados: La escala de motivos a favor de la RM del CMRM presentó una estructura unidimensional, consistencia interna excelente y validez convergente. La escala de motivos en contra de la RM presentó una estructura de tres factores: miedos/preocupaciones/costos, aceptación/satisfacción con el estado actual y falta de información. Sus tres factores presentaron consistencia interna y validez convergente y discriminante. La correlación entre ambas escalas fue pequeña, pero la consistencia interna del CMRM fue excelente. La fuerza de asociación del CMRM fue muy fuerte con deseo de RM, media con edad e imagen corporal y pequeña con deseo de conservar la mama, frecuencias de relaciones sexuales antes del diagnóstico, búsqueda de información sobre RM y percepción del estado económico. Fue independiente de escolaridad, etapa del cáncer, tipo de mastectomía y estado civil. Conclusión: el cuestionario es fiable y válido

Backgrounds: Although breast reconstruction (BR) after mastectomy is an aesthetic option with good results, it is done little in Mexico. To study its reasons, the Questionnaire of Motives for and against Breast Reconstruction (QMBR) was created. The content validity of the QMBR has been tested, but not other psychometric properties. The objectives of the study were to determine its factor structure, and to test its reliability and concurrent construct validity. This instrumental research with non-experimental cross-sectional design used an intentional sampling. The QMBR consisting of two scales,a body image questionnaire, and questions about sociodemographic, clinical and sexual behavior data were applied to 110 Mexican mastectomized women. The QMBR scale of motives for BR presented a one-factor structure, excellent internal consistency, and convergent validity. The QMBR scale of motives against BR presented a structure of three factors: fears/concerns/cost, acceptance/satisfaction with the current state, and lack of information. Its three factors showed internal consistency and convergent validity and discriminant. The correlation between both scales was small, but the internal consistency of QMBR was excellent. The strength of association of QMBR was very strong with desire for BR; medium with age and body image; and small with desire to preserve the breast, frequencies of sexual relations before diagnosis, search for information on BR, and perception of economic status. The QMBR was independent of levels of education, stage of cancer, type of mastectomy, and marital status.It is concluded that the questionnaire is reliable and valid