Quality of Life After Postmastectomy Breast Reconstruction
Purpose/Objectives: To explore women's expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction.
Design: Qualitative focus group study.
Setting: Integrated healthcare system in a midwestern suburban community.
Sample: 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer.
Methods: An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization.
Findings: Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence.
Conclusions: Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence.
Implications for Practice: Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.
Jump to a section
References
Anderson, S.G., Rodin, J., & Ariyan, S. (1994). Treatment considerations in postmastectomy reconstruction: Their relative importance and relationship to patient satisfaction. Annals of Plastic Surgery, 33, 263--271.
Appleton, J.V. (1995). Analyzing qualitative and interview data: Addressing issues of validity and reliability. Journal of Advanced Nursing, 22, 993--997.
Burnard, P. (1991). A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11, 461--466.
Dean, C., Chetty, U., & Forrest, A.P.M. (1983). Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet, 1 (8322), 459--462.
Fitzpatrick, R., & Hopkins, A. (1983). Problems in the conceptual framework of patient satisfaction research: An empirical exploration. Sociology of Health and Illness, 5, 297--311.
Giacomini, M.K., & Cook, D.J. (2000). Users' guides to the medical literature. XXIII. Qualitative research in health care A. Are the results of the study valid? JAMA, 284, 357--362.
Goldwyn, R.M. (1987). Breast reconstruction after mastectomy. New England Journal of Medicine, 317, 1711--1714.
Handel, N., Silverstein, M.J., Waisman, E., & Waisman, J.R. (1990). Reasons why mastectomy patients do not have breast reconstruction. Plastic and Reconstructive Surgery, 86, 1118--1122.
Hart, D. (1996). The psychological outcome of breast reconstruction. Plastic Surgical Nursing, 16, 167--171.
Hart, S., Meyerowitz, B.E., Apolone, G., Mosconi, P., & Liberati, A. (1997). Quality of life among mastectomy patients using external breast prostheses. Tumori, 83, 581--586.
Krueger, R.A. (1998). Focus group kit: Vol. 6. Analyzing and reporting focus group results. Thousand Oaks, CA: Sage.
Mock, V. (1993). Body image in women treated for breast cancer. Nursing Research, 42, 153--157.
Montgomery, L.L., Tran, K.N., Heelan, M.C., Van Zee, K.J., Massie, M.J., Payne, D.K., et al. (1999). Issues of regret in women with contralateral prophylactic mastectomies. Annals of Surgical Oncology, 6, 546--552.
Neill, K.M., Armstrong, N., & Burnett, C.B. (1998). Choosing reconstruction after mastectomy: A qualitative analysis. Oncology Nursing Forum, 25, 743--750.
Nissen, M.J., Swenson, K.K., Ritz, L.J., Farrell, J.B., Sladek, M.L., & Lally, R.M. (2001). Quality of life after breast cancer surgery: A comparison of three surgical procedures. Cancer, 91, 1238--1246.
Noone, R.B., Frazier, T.G., Hayward, C.Z., & Skiles, M.S. (1982). Patient acceptance of immediate reconstruction following mastectomy. Plastic and Reconstructive Surgery, 69, 632--638.
Noone, R.B., Murphy, J.B., Spear, S.L., & Little, J.W. (1985). A six-year experience with immediate reconstruction after mastectomy for cancer. Plastic and Reconstructive Surgery, 76, 258--269.
Powell, R.A., & Single, H.M. (1996). Methodology matters---V. Focus groups. International Journal for Quality in Health Care, 8, 499--504.
Pusic, A., Thompson, T.A., Kerrigan, C.L., Sargeant, R., Slezak, S., Chang, B.W., et al. (1999). Surgical options for early-stage breast cancer: Factors associated with patient choice and postoperative quality of life. Plastic and Reconstructive Surgery, 104, 1325--1333.
Ratner, E. (1999). The feisty woman's breast cancer book. Alameda, CA: Hunter House.
Reaby, L.L., & Hort, L.K. (1995). Postmastectomy attitudes in women who wear external breast prostheses compared to those who have undergone breast reconstructions. Journal of Behavioral Medicine, 18, 55--67.
Reaby, L.L., Hort, L.K., & Vandervord, J. (1994). Body image, self-concept, and self-esteem in women who had a mastectomy and either wore an external breast prosthesis or had breast reconstruction and women who had not experienced mastectomy. Health Care for Women International, 15, 361--375.
Ritz, L.J., Nissen, M.J., Swenson, K.K., Farrell, J.B., Sperduto, P.W., Sladek, M.L., et al. (2000). Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncology Nursing Forum, 27, 923--932.
Rowland, J.H., Desmond, K.A., Meyerowitz, B.E., Belin, T.R., Wyatt, G.E., & Ganz, P.A. (2000). Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. Journal of the National Cancer Institute, 92, 1422--1429.
Rowland, J.H., Dioso, J., Holland, J.C., Chaglassian, T., & Kinne, D. (1995). Breast reconstruction after mastectomy: Who seeks it, who refuses? Plastic and Reconstructive Surgery, 95, 812--822.
Rowland, J.H., & Holland, J.C. (1989). Breast cancer. In J.C. Holland & J.H. Rowland (Eds.), Handbook of psycho-oncology: Psychological care of the patient with cancer (pp. 188--207). New York: Oxford University Press.
Rowland, J.H., Holland, J.C., Chaglassian, T., & Kinne, D. (1993). Psychological response to breast reconstruction. Expectations for and impact on postmastectomy functioning. Psychosomatics, 34, 241--250.
Schain, W.S. (1991). Breast reconstruction. Update of psychosocial and pragmatic concerns. Cancer, 68(Suppl. 5), 1170--1175.
Schain, W.S., Jacobs, E., & Wellisch, D.K. (1984). Psychosocial issues in breast reconstruction. Intrapsychic, interpersonal, and practical concerns. Clinics in Plastic Surgery, 11, 237--251.
Schain, W.S., Wellisch, D.K., Pasnau, R.O., & Landsverk, J. (1985). The sooner the better: A study of psychological factors in women undergoing immediate versus delayed breast reconstruction. American Journal of Psychiatry, 142, 40--46.
Stevens, L.A., McGrath, M.H., Druss, R.G., Kister, S.J., Gump, F.E., & Forde, K.A. (1984). The psychological impact of immediate breast reconstruction for women with early breast cancer. Plastic and Reconstructive Surgery, 73, 619--626.
Wellisch, D.K., DiMatteo, R., Silverstein, M., Landsverk, J., Hoffman, R., Waisman, J., et al. (1989). Psychosocial outcomes of breast cancer therapies: Lumpectomy versus mastectomy. Psychosomatics, 30, 365--373.
Yurek, D., Farrar, W., & Andersen, B.L. (2000). Breast cancer surgery: Comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. Journal of Consulting and Clinical Psychology, 68, 697--709.