The Metamorphosis of Patient Priorities Throughout the Breast Reconstruction Process.

BACKGROUND: Breast reconstruction is a lengthy, multi-stage process guided by patients. It is vital to understand how their goals vary over time in order 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 tests were used to make pairwise comparisons between time points.

RESULTS: Survival scores decreased between 3 and 12 months after surgery (p < 0.001) before returning to baseline at long-term follow-up. Restitution scores were lowered only at 12 months PO (T4 vs. T1, T2, and T3, p < 0.001; T4 vs. T5, p = 0.003). Symmetry scores increased from preop to 6 months post-operation (p < 0.001), and then fell back to baseline by month 12 (p < 0.001) and remained at that level at long-term follow-up. Enhancement scores increased from pre-op to 12 months after surgery (p < 0.001), before returning to baseline at 10 year follow-up (T1 vs. T5, p > 0.99; T4 vs T5, p < 0.001). Time had an overall significant effect on each subsection score (p < 0.001), 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 ten years after surgery, patients' priorities were virtually unchanged from their preoperative desires.