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Gallo L, Kaur M, Tsangaris E, Griffith L, Nelson JA, Pusic AL, Klassen AF, Voineskos S. Patient factors associated with cancer worry post-breast reconstruction: A cross-sectional study. J Plast Reconstr Aesthet Surg 2024; 93:173-182. [PMID: 38703705 DOI: 10.1016/j.bjps.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 04/05/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE The BREAST-Q Breast Cancer module is a patient-reported outcome measure for women with breast cancer diagnosis. Our research team developed and validated a novel BREAST-Q scale for this module that measures quality of life outcomes specific to cancer worry. The aim of this study was to investigate patient related breast reconstruction factors that are associated with worse scores on the new BREAST-Q Cancer Worry Scale. METHODS Women with a history of breast cancer treated with mastectomy and reconstruction, aged ≥18 years, and English-speaking were recruited through the Love Research Army between October and November 2019. Participants completed demographic and clinical questions alongside the BREAST-Q Cancer Worry Scale. Univariable and multivariable regression analyses were used to identify participant characteristics associated with cancer worry scores. RESULTS Among the 554 potential respondents, 538 (97.1%) completed the Cancer Worry Scale. The average patient age was 58.4 (+9.8) years. Cancer Worry scores were normally distributed with a mean of 46.4 (+17.2). Cancer Worry scores were significantly associated (p < 0.01) with younger age, history of radiation therapy, complications associated with breast surgery since diagnosis, use of textured breast implants, and shorter duration since surgery. CONCLUSIONS This exploratory analysis provides evidence of patient characteristics that may be associated with cancer worry following postmastectomy breast reconstruction.
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Affiliation(s)
- Lucas Gallo
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada.
| | - Manraj Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Tsangaris
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada
| | - Sophocles Voineskos
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
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Newlan TM, Greig J. The marked body: Exploring experiences of post-mastectomy scarring, body image and change through artistic tattooing. J Health Psychol 2024; 29:382-395. [PMID: 38102733 PMCID: PMC11005302 DOI: 10.1177/13591053231215050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Breast cancer has become the most prevalent cancer globally, predominantly affecting women, with mastectomy surgery a frequent treatment. Women often experience a discrepancy between their post-mastectomy body, and their former sense of self, affecting negatively on wellbeing. The narratives of eight women who chose to artistically tattoo over their mastectomy scars were explored in this study, through semi-structured interviews and Interpretative Phenomenological Analysis (IPA). Seven master themes are presented. These themes follow the women from a state of disruption (of body image and gender identity) and surgical scarring as the first marking of the body, to the second marking of the body through artistic tattooing, bringing with it transformation, acceptance, feeling heard and connection with the artist, closure and control and the creation of significance and meaning. Viewed through Self-Discrepancy Theory, the findings of this study has implications for psycho-oncology and wellbeing support for women following mastectomy surgery.
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Affiliation(s)
| | - Jenni Greig
- Charles Sturt University—Bathurst Campus, Australia
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Freeman N, Watson S, Barnes C, Warland J, Rose M, Bradfield Z. A survey of Australian midwives: Experts in nitrous oxide administration within the peripartum setting. Women Birth 2023; 36:520-528. [PMID: 37308354 DOI: 10.1016/j.wombi.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
PROBLEM There is little documented evidence of midwives' perspectives regarding the use of nitrous oxide in the peripartum period. BACKGROUND Nitrous oxide is an inhaled gas used widely in the peripartum period; usually offered and managed by midwives. AIM Explore midwives' knowledge, perceptions, and practices of facilitating women's use of nitrous oxide in the peripartum period. METHODS An exploratory cross-sectional survey design was used. Quantitative data were analysed using descriptive and inferential statistics; open-ended responses underwent template analysis. FINDINGS Midwives (n = 121) working in three Australian settings reported regularly recommending the use of nitrous oxide and high levels of knowledge and confidence supporting its use. There was a significant association between midwifery experience, and perspectives on women's capacity to use nitrous effectively (p = 0.004); and desire for refresher education (p < 0.001). Midwives working in continuity models were more likely to support women using nitrous oxide in any situation (p = 0.039). DISCUSSION Midwives demonstrated expertise in facilitating nitrous oxide use, citing utility to relieve anxiety and distract women from pain or discomfort. Nitrous oxide was identified as an important adjunct to the provision of supportive care requiring midwifery therapeutic presence. CONCLUSION This study provides novel insight into midwives' support of nitrous oxide use in the peripartum setting revealing high levels of knowledge and confidence. Recognition of this unique expertise held by midwives is important to ensure transfer and development of professional knowledge and skills and emphasises the need for midwifery leadership in clinical service provision, planning and policy.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia; King Edward Memorial Hospital, Western Australia, Australia
| | - Stuart Watson
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia
| | - Courtney Barnes
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia
| | - Jane Warland
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia; King Edward Memorial Hospital, Western Australia, Australia
| | - Monique Rose
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia
| | - Zoe Bradfield
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia; King Edward Memorial Hospital, Western Australia, Australia.
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Smeele HP, Dijkstra RCH, Kimman ML, van der Hulst RRWJ, Tuinder SMH. Patient-Reported Outcome Measures Used for Assessing Breast Sensation after Mastectomy: Not Fit for Purpose. THE PATIENT 2022; 15:435-444. [PMID: 35040096 PMCID: PMC9197899 DOI: 10.1007/s40271-021-00565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
Abstract
AIMS The aims of this review were (i) to evaluate whether patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are suitable for this purpose, and (ii) to explore whether any measures used for assessing sensation after non-oncologic breast surgery are worth modifying for use in post-mastectomy patients. METHODS PRISMA guidelines were followed (PROSPERO number CRD42020178066). We searched six databases for studies of oncologic (i.e., therapeutic, prophylactic, and reconstructive) and non-oncologic breast surgery (e.g., breast reduction) in which sensation was assessed with a patient-reported outcome measure. From the selected studies, we extracted eligible measures, evaluated their fitness for purpose, and summarized the content of sensation-specific items. RESULTS Of 6728 articles identified, we selected 135 studies that used 124 eligible patient-reported outcome measures. For 97% of these measures, details regarding development and measurement properties were unavailable. Four (3%) validated measures-the Sensory Disturbances subscale of the Breast Cancer Sequelae Cause Scales, the Discomfort subscale of the Breast Sensation Assessment Scale (BSAS), Didier et al.'s questionnaire for "Assessment of the patients' satisfaction with cosmetic results, physical and emotional impact of mastectomy", and the Breast Specific Pain subscale of the Breast Cancer Treatment Outcomes Scale (BCTOS)-each contain at least one item pertaining to breast sensation, but target different concepts of interest. In total, the measures feature 215 sensation-specific items, most of which concern symptom severity (97%) as opposed to impact on daily functioning (3%). CONCLUSION Patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are unsuitable for this purpose: they are either non-validated or non-specific. We failed to identify any measures for use in non-oncologic breast surgery populations worth modifying. To collect meaningful, patient-relevant data regarding sensation after mastectomy, it is pertinent that future clinical trials adopt psychometrically robust, specific patient-reported outcome measures.
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Affiliation(s)
- Hansje P Smeele
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rachel C H Dijkstra
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Stefania M H Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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"Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies". Plast Reconstr Surg 2022; 150:243-255. [PMID: 35652898 DOI: 10.1097/prs.0000000000009306] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary cadaveric studies were reviewed to give a contemporary overview of what is known about innervation of the female breast and nipple/nipple-areola complex (NAC). METHODS We performed a PRISMA-compliant systematic review and meta-analysis (PROSPERO number CRD42020150250). We searched four electronic databases for studies investigating which nerve branches supply the female breast and nipple/NAC or describing the trajectory and other anatomical features of these nerves. Inclusion criteria for meta-analysis were at least five studies of known sample size and with numerical observed values. Pooled prevalence (PP) estimates of nerve branches supplying the nipple/NAC were calculated using random-effects meta-analyses; the remaining results were structured using qualitative synthesis. Risk of bias within individual studies was assessed with the Anatomical Quality Assurance (AQUA) checklist. RESULTS Of 3653 studies identified, 19 were eligible for qualitative synthesis and 7 for meta-analysis. The breast skin is innervated by anterior cutaneous branches (ACBs) and lateral cutaneous branches (LCBs) of the 2nd - 6th and the nipple/NAC primarily by ACBs and LCBs of the 3rd - 5th intercostal nerves. The ACB and LCB of the 4th intercostal nerve supply the largest surface area of the breast skin and nipple/NAC. The LCB of the 4th intercostal nerve is the most consistent contributory nerve to the nipple/NAC (PP 89.0%; 95% CI 0.80-0.94). CONCLUSIONS The ACB and LCB of the 4th intercostal nerve are the most important nerves to spare or repair during reconstructive and cosmetic breast surgery. Future studies are required to elicit the course of dominant nerves through the breast tissue.
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Fontein DB, Oros M, Held L, Giovanoli P, Pusic AL, Lindenblatt N. Patient-Reported Outcomes in Free-Flap Breast Reconstructive Surgery over Time (PRO-BREST). Breast Care (Basel) 2022; 17:272-278. [PMID: 35949418 PMCID: PMC9247488 DOI: 10.1159/000519804] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/02/2021] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROMs) are increasingly relevant to assess surgical quality and guide decisions in breast reconstruction (BR). Satisfaction with outcomes may change as time progresses. We assessed satisfaction in patients who underwent free-flap BR in the last 12 years. METHODS All patients who underwent free-flap BR from 2006 to 2018 were invited to complete the validated BREAST-Q for reconstruction. The BREAST-Q comprises 6 domains covering various aspects of satisfaction. Unadjusted linear regression assessed the relationship between different domains of the BREAST-Q and time since BR. Two-sample t tests assessed differences in satisfaction between patients who underwent BR ≥5 years versus <5 years prior. RESULTS Forty-three women with primary or secondary free-flap BR between 2006 and 2018 were included in the study. Most patients (n = 33, 76.7%) underwent DIEP flap BR. Overall satisfaction with breasts and with outcomes improved as time since BR increased (p = 0.031 and p = 0.017, respectively). Overall satisfaction with outcomes scored higher in patients with BR ≥5 years prior (≥5 years vs. <5 years: breast score 88.6 (SD 12.5) versus 66.9 (SD 21.8); p = 0.005). Satisfaction with breasts and psychosocial well-being also scored higher in these patients. There was no difference in results between primary and secondary BR. Patients who underwent additional surgery (refinements) reported higher satisfaction with outcomes and abdominal well-being. CONCLUSIONS PROMs concerning satisfaction with breast and with outcomes following BR improve as time since treatment progresses. This study demonstrates that time since diagnosis may be an important factor in satisfaction. It underlines the importance of long-term PROMs related to BR, to help provide patients and health care professionals in decision-making and in managing expectations related to BR.
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Affiliation(s)
- Duveken B.Y. Fontein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Melanie Oros
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Andrea L. Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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Régis C, Le Deley MC, Bogart E, Leguillette C, Boulanger L, Chauvet MP, Viard R, Thery J, Bosc R, Delmaire C. Functional Cerebral MRI Evaluation of Integration of Breast Reconstruction into the Body Schema. Ann Surg Oncol 2021; 29:2652-2661. [PMID: 34839425 DOI: 10.1245/s10434-021-11048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of breast reconstruction (BR) is to erase the after-effects of total mastectomy by allowing patients to restore their breast shape. The aim of our study was to investigate the body map integration of different types of BR using functional magnetic resonance (fMRI). PATIENTS AND METHODS We prospectively enrolled all women undergoing BR for breast cancer to the Remasco study (NCT02553967). Participants were categorized into four groups according to the standard of care they required: immediate BR (IBR), delayed BR (DBR), flap (autologous), or implant BR. Each patient performed sensorimotor tasks during the fMRI acquisition. RESULTS Data of 38 patients were analyzed. We identified the cingulate region as the area of interest in the brain. In the case of DBR, the brain area activated during palpation of the total mastectomy scar (before BR) was different from the brain area activated during palpation of the reconstructed breast (Brodmann areas 31 versus 32). Palpation of the native breast and reconstructed breast activated the same Brodmann area 32. Comparing the brain activation signal during palpation of the native breast and the reconstructed breast did not reveal any significant difference in the overall population (P = 0.41) or in the groups: autologous (P = 0.32), implant (P = 0.10), IBR (P = 0.72), or DBR (P = 0.10). CONCLUSIONS This experimental study allowed us to describe and understand the brain plasticity processes that accompany BR. The results suggest that the reconstructed breast is integrated into the body schema, regardless of the type of BR or the timing.
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Affiliation(s)
- Claudia Régis
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France.
| | - Marie-Cécile Le Deley
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France.,Université Paris-Saclay, Universite´ Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Emilie Bogart
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Clémence Leguillette
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Loic Boulanger
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Marie- Pierre Chauvet
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Romain Viard
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France.,University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Julien Thery
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Romain Bosc
- Department of Plastic, Reconstructive, Aesthetic and maxillofacial Surgery, Henry Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France
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Everaars KE, Welbie M, Hummelink S, Tjin EPM, de Laat EH, Ulrich DJO. The impact of scars on health-related quality of life after breast surgery: a qualitative exploration. J Cancer Surviv 2021; 15:224-233. [PMID: 32816201 PMCID: PMC7966197 DOI: 10.1007/s11764-020-00926-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/01/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of this research was to explore women's experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). MATERIAL AND METHODS A qualitative study using semi-structured face-to-face interviews was conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were "physical and sensory symptoms," "impact of scar symptoms," "personal factors," "impact of scar interventions," and "change over time." RESULTS The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. CONCLUSION Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. IMPLICATIONS FOR CANCER SURVIVORS Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.
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Affiliation(s)
- Kristel E. Everaars
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Marlies Welbie
- Research Center Healthy and Sustainable Living, Research group Methodology of Practice-Based Research, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Esther P. M. Tjin
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Erik H. de Laat
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
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Mace S, Collins S, Speer S. Talking about breast symmetry in the breast cancer clinic: What can we learn from an examination of clinical interaction? Health Expect 2021; 24:209-221. [PMID: 33517586 PMCID: PMC8077149 DOI: 10.1111/hex.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/30/2020] [Accepted: 09/06/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Breast asymmetry is a common post-operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions. OBJECTIVE To examine clinical communication about breast symmetry in real-time consultations in a breast cancer clinic. DESIGN Seventy-three consultations between 16 clinicians and 47 patients were video-recorded, transcribed and analysed using conversation analysis. RESULTS In most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient. CONCLUSION Current clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient's individual stance on breast symmetry, and optimize doctor-patient alignment.
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Affiliation(s)
- Stephanie Mace
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Collins
- Division of Medical Education, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Susan Speer
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
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10
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Tan YY, Chin YR, Bajaj K, Thomas S. Patient-reported outcomes for nipple reconstruction: Review of literature. Surgeon 2021; 19:e245-e255. [PMID: 33423920 DOI: 10.1016/j.surge.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/04/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature. METHODS Systematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction. RESULTS Fifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area. CONCLUSION There is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.
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Affiliation(s)
- Yan Yu Tan
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Ye Ru Chin
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Kuljyot Bajaj
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sunil Thomas
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
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Ahn J, Suh EE. [The Lived Experience of Body Alteration and Body Image with Regard to Immediate Breast Reconstruction among Women with Breast Cancer]. J Korean Acad Nurs 2021; 51:245-259. [PMID: 33993129 DOI: 10.4040/jkan.21028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to explore the lived experience of body alteration and body image with regard to immediate breast reconstruction among women with breast cancer. METHODS Data were collected from July to December 2020 through individual in-depth interviews with 15 women who had undergone immediate breast reconstruction due to breast cancer. Verbatim transcripts were analyzed using Colaizzi's phenomenological analysis. RESULTS The following four theme clusters emerged. First, "revalued meaning of breasts due to cancer" illustrated the fact that cancer removal surgery brought the participants to reconsider the meaning of their breasts. Second, "had no choice but breast reconstruction" demonstrated the participants' decision-making process of not wanting to lose breasts. Third, "unsatisfied breasts despite reconstruction" portrayed the distress due to the unexpected surgical outcomes. Finally, "restarted everyday routines with the altered body" described the healing process of the participants by accepting their changed body. CONCLUSION In Korea, where family-centeredness and fidelity are highly valued, women perceived their breasts not only as a symbol of femininity but as the mediator connecting the self to family. Despite the distress related to imperfect breasts, the participants were thankful for their reconstructed breasts. Breast reconstruction helped them return to daily life as the psychological trauma of breast cancer was healed. The participants rebuilt their body image by accepting their scarred new body. This may allow health professionals to provide constructive and culturally appropriate counseling in advance by providing insight into women's perception of their body image with regard to breast reconstruction.
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Affiliation(s)
- Jeonghee Ahn
- College of Nursing, Seoul National University, Seoul, Korea
| | - Eunyoung E Suh
- College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
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12
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Trotter K, Plichta JK, Zenn M. A Tale of Two Sisters: Breast Reconstruction Options for Women With or at High Risk of Breast Cancer. J Adv Pract Oncol 2020; 11:173-179. [PMID: 33532116 PMCID: PMC7848809 DOI: 10.6004/jadpro.2020.11.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Breast reconstructive surgery has changed significantly over the past decade. The incidence of nipple-sparing procedures and prophylactic mastectomy has also increased significantly as women and their surgeons use shared decision-making strategies. The following case history of two sisters, one with breast cancer and one at elevated risk for breast cancer, highlights the current standard of care with newer gold-standard procedures for mastectomy and subsequent reconstruction. A comparison of types of mastectomies, steps in reconstruction, and reconstruction options are discussed.
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Sousa H, Castro S, Abreu J, Pereira MG. A systematic review of factors affecting quality of life after postmastectomy breast reconstruction in women with breast cancer. Psychooncology 2019; 28:2107-2118. [DOI: 10.1002/pon.5206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Helena Sousa
- Family Health and Illness Research Group, School of PsychologyUniversity of Minho Braga Portugal
| | - Sónia Castro
- Breast Cancer Clinic/Psycho‐Oncology ServiceFrancisco Gentil Portuguese Institute of Oncology of Porto Porto Portugal
| | - Joaquim Abreu
- Breast Cancer Clinic/Head of the Surgical Oncology DepartmentFrancisco Gentil Portuguese Institute for Oncology of Porto Porto Portugal
| | - M. Graça Pereira
- Family Health and Illness Research Group, School of PsychologyUniversity of Minho Braga Portugal
- Research Center in Psychology (CIPsi), School of PsychologyUniversity of Minho Braga Portugal
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