Patients Had Inaccurate Expectations of Well-Being After Mastectomy

Women undergoing mastectomy did not have an accurate idea of their future well-being, according to the results of a study published in JAMA Surgery. Women who underwent mastectomy without immediate reconstruction underestimated their future well-being and those who did get reconstruction overestimated their well-being.

“Misprediction was associated with greater regret but not with satisfaction with decisions,” wrote Clara Nan-hi Lee, MD, MPP, of the Ohio State University in Columbus, and colleagues. “Decision support for mastectomy and breast reconstruction should address expectations about future well-being.”

The study was designed to help determine how well patients undergoing mastectomy predicted their future well-being. The prospective single-center study included 145 women scheduled to undergo mastectomy for stage 1, 2, or 3 invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis.

Preoperative measures included 12-month happiness and quality-of-life prediction, as well as predicted satisfaction with breasts, sexual attractiveness, breast numbness, and pain. At 12 months, participants completed the Decision Regret Scale and Satisfaction With Decisions Scale.

Of the 145 patients surveyed, 131 returned the survey, and 111 of those participants remained at 12 months. Fifteen participants ultimately delayed reconstructive surgery, leaving a final group of 96 women, 54 of whom had no reconstruction.

The mean age of patients was 53.9 years. Those patients who underwent mastectomy with no reconstruction underestimated their future well-being in all measured domains. There were significant differences for both quality of life and satisfaction prediction. For example, patients predicted a mean quality-of-life score of 68 on a scale from 1 to 100, but experienced a mean score of 74.

According to the researchers, the difference was small, but “they may have been large enough to influence decisions.”

In contrast, patients who had reconstruction overestimated future well-being, with significant differences in predicted and actual outcomes for satisfaction with breasts-unclothed, sexual attractiveness-clothed, and sexual attractiveness-unclothed.

“Patients’ expectations of appearance and attractiveness unclothed may be a particularly important aspect of decisions about reconstruction,” the researchers wrote. “The unclothed domains had the largest prediction errors by patients who had mastectomy with reconstruction.”

In addition, a higher percentage of these patients had more severe symptoms than they predicted compared with women who did not undergo reconstruction.

“Importantly, patients undergoing mastectomy without reconstruction anticipated a decline in well-being compared with their baseline scores in every domain, and patients undergoing mastectomy with reconstruction anticipated an improvement in nearly every domain,” the researchers wrote. “We were surprised by patients’ apparent belief that mastectomy with reconstruction would improve appearance over their baseline levels. We speculate that some patients may confuse aesthetic plastic surgery (ie, breast augmentation) with reconstructive plastic surgery.”

Finally, the study showed that those patients who were less happy or had greater pain than they predicted had significantly greater regret.