Perspectives of Women Who Forgo Post-mastectomy Breast Reconstruction: A Mixed Methods Analysis

Tanvee Singh, Lakshmi Goparaju, Aviram M. Giladi, Oluseyi Aliu, David H. Song, Kenneth L. Fan

Research output: Contribution to journalArticlepeer-review


Background: Despite a growing body of evidence suggesting improved psychosocial well-being and survival after post-mastectomy breast reconstruction (PMBR), rates remain stagnant at approximately 40%. Although PMBR access and utilization have been well reported, there is much less known from the point of view of women who decide not to undergo PMBR. This study uses a mixed methods approach to fill that gap by investigating the patient-level decisions that lead to foregoing PMBR. Methods: A concurrent triangulation model under mixed methods research (MMR) was employed using in-depth qualitative interviews and the BREAST-Q questionnaire. Interviews were conducted until data saturation was reached and were analyzed using iterative methodologies under the grounded-Theory framework. Reliability checks included inter-rater reliability using Cohen's kappa statistic (mean kappa = 0.99) and triangulation. Results: Interviews with 8 patients who declined PMBR revealed (1) lack of trust in plastic surgeons; (2) reliance on self-developed support; (3) desire to resume normal life; (4) perceived lack of equivalency between reconstructed and natural breasts. Concurrent triangulation between the data revealed dissonance between the BREAST-Q scores for psychosocial well-being and reported levels of satisfaction. Conclusions: Women in this study highlighted certain deficits in the current pathway to reconstruction: lack of trust, resources, and counseling. Such feelings of suspicion and reported opposition to PMBR are at odds with low scores for satisfaction with breasts and sexual well-being. These findings can be used to guide efforts that engender confidence, provide support, empower vulnerable patient groups, and increase utilization of PMBR.

Original languageEnglish (US)
Article numbere3203
JournalPlastic and Reconstructive Surgery - Global Open
StateAccepted/In press - 2021

ASJC Scopus subject areas

  • Surgery


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