Introduction: Breast reconstruction aims to improve quality of life after mastectomy, but women's underlying goals vary widely and are often complex. Limited research has explored how these goals differ according to indication for mastectomy, timing of reconstruction, or reconstructive technique. Understanding patients' goals is essential for shared decision-making, managing expectations, and improving patient satisfaction.
Methods: This cross-sectional mixed-methods study included women undergoing breast reconstruction within the preference arm of the GoBreast II trial at a Swedish university hospital. Participants completed a preoperative PEGASUS (Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) consultation to identify individual goals. Goals were analyzed using inductive qualitative content analysis and quantified by category frequency. Comparisons were made between reconstructive technique (autologous vs. implant-based), timing (immediate vs. delayed), and indication for mastectomy (therapeutic vs. risk-reducing).
Results: Eighty-nine women were included (median age 48 years). Five main goal categories were identified: Achieving a feeling, just wanting the breast back, Aesthetic wishes, Practical matters, and the process. Women opting for implant-based reconstruction expressed more aesthetic goals than those choosing autologous reconstruction. Patients undergoing delayed reconstruction reported more goals related to practical matters. Women undergoing risk-reducing mastectomy expressed more aesthetic wishes and fewer practical concerns than women treated for breast cancer.
Conclusions: Women's goals for breast reconstruction extend beyond physical restoration and include emotional, identity-related, and aesthetic dimensions. Structured identification of patient goals may improve preoperative counselling, shared decision-making, and management of expectations in breast reconstruction.
Anna Paganini, Susanne Ahlstedt Karlsson, Linda Myrin Westesson, Camilla Larsson, Alexandra Uusimäki, Karolina Svensson, Timea Sparding, Emma Hansson
Disease Category: Cancer
Disease Name: Breast cancer
Age Range: 18 - 120
Sex: Either
Nature of Intervention: Surgery
- Consumers (patients)
- Patient perspectives
- Other
- Semi structured discussion
Used a mixed-methods design to capture qualitative content (individual's goals) and quantitative aspects. For the qualitative analysis, an inductive approach and content analysis according to Elo and Kyngäs [18] were used to analyze the identified individual goals. For the quantitative analysis, percentages of goals within every qualitative category of total goals were calculated for each patient. Comparisons between groups were performed using the Mann–Whitney test.