Improving preparedness prior to reconstructive breast surgery via inclusion of 3D images during pre-operative counselling: a qualitative analysis

Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear.

OBJECTIVE

We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR.

METHODS

This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low.

CONCLUSIONS

The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR.

TRIAL REGISTRATION

PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.

Three-Dimensional Surface Analysis for Preoperative Prediction of Breast Volume: A Validation Study

BACKGROUND

Few studies have examined whether preoperative three-dimensional surface imaging can accurately predict breast volume. Reliably predicting breast volume preoperatively can assist with breast reconstruction planning, patient education, and perioperative risk stratification.

METHODS

The authors conducted a review of patients who underwent mastectomy from 2020 to 2021 and included all patients who had preoperative VECTRA XT three-dimensional imaging. VECTRA Analysis Module (VAM) and VECTRA Body Sculptor (VBS) were used for volumetric analysis using standard anatomical breast borders. Breast weights were obtained intraoperatively. Predictive accuracy was defined as VAM estimates ±10% of mastectomy specimen weight or ±100 g of mastectomy weight.

RESULTS

The study included 179 patients (266 breasts). There was no significant difference ( P = 0.22) between mean mastectomy weight of 620.8 ± 360.3 g and mean VAM estimate of 609.5 ± 361.9 g. Mean VBS estimate was 498.9 ± 337.6 g, which differed from mean mastectomy weight ( P < 0.001). When defining predictive accuracy as ±100 g, 58.7% of VAM and 44.4% of VBS estimates were accurate. Body mass index, body surface area, and ptosis grade significantly affected VAM and VBS breast volume predictions.

CONCLUSIONS

VAM is more accurate at predicting mastectomy weight than VBS, likely because of VAM's analysis of surface topography rather than discrete surface landmarks. Discrepancies between VECTRA estimates and mastectomy weight were likely attributable to differences between surgical mastectomy borders and breast borders used in volumetric analysis. Surgeons should consider the physical characteristics of patients when using three-dimensional imaging.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Diagnostic, I.

Satisfaction survey on a preoperative explanation method using three-dimensional breast imaging for breast cancer patients considering breast-conserving surgery

PURPOSE

Although one of the essential factors in surgical shared decision-making is the body image, the breast morphology after breast-conserving surgery is particularly difficult to explain in a uniform manner due to large individual differences.

METHODS

Patients with breast cancer eligible for breast-conserving surgery (BCS) were recruited between June 2020 and October 2021. We surveyed the patients' satisfaction with our method of explaining the likely breast morphology after BCS using three-dimensional (3D) breast imaging in the form of a questionnaire.

RESULTS

A total of 162 patients were enrolled, and 137 (84.6%) answered the questionnaire. One hundred and sixteen patients (84.6%) answered that they were very satisfied or satisfied with our explanation method, and 100 (73.0%) patients were very satisfied or satisfied with the 3D breast imaging. Some patients answered that 3D breast imaging helped them prepare for BCS, or on the contrary, made them choose mastectomy with breast reconstruction because the deformation likely with BCS was considered unacceptable. Only a few patients who underwent BCS felt that their postoperative morphology was more deformed than the preoperatively imagined one.

CONCLUSION

Our results suggest that our preoperative explanation method using 3D breast imaging was useful for shared decision-making.

Study on the Effect of Positive Psychological Intervention Based on PERMA Model on Perioperative Patients with AIDS Complicated with Breast Cancer

Objective. To study the effect of positive psychological intervention based on PERMA model on perioperative AIDS patients complicated with breast cancer. Methods. A total of 120 perioperative patients with AIDS complicated with breast cancer treated in our hospital from January 2021 to December 2021 were randomly divided into research group ( $n=60$ ) and control group ( $n=60$ ). The research group received positive psychological intervention based on PERMA model, while the control group received routine nursing. The scores of disease uncertainty scale (MUIS), Frankl treatment compliance scale, cancer-related fatigue scale, self-rating anxiety scale (SAS), self-rating depression scale (SDS), and quality of life scale EORTCQLQ-C30 (v3.0) were studied. Results. After 12-week nursing, the MUIS score of the research group was lower than that of the control group, and the difference was statistically significant ( $P<0.05$ ). After 12 weeks of nursing, the score of Frankl treatment compliance scale in the research group was higher than that in the control group, and the difference was statistically significant ( $P<0.05$ ). Following 12-week nursing, the scores of SAS and SDS in the research group were lower than those in the control group, and the difference was statistically significant ( $P<0.05$ ). After 12 weeks of nursing, the score of cancer-related fatigue scale in the research group was lower than that in the control group, and the difference was statistically significant ( $P<0.05$ ). The EORTCQLQ-C30 (v3.0) scale-symptom domain score in the research group was lower than that in the control group following 12-week nursing, and the difference was statistically significant ( $P<0.05$ ). After 12 weeks of nursing, the EORTCQLQ-C30 (v3.0) scale-overall health domain score and functional domain score in the research group were higher than those in the control group, and the difference was statistically significant ( $P<0.05$ ). Conclusion. The application value of positive psychological intervention based on PERMA model in perioperative patients with AIDS complicated with breast cancer is more significant. It contributes more to treatment compliance and improves negative feelings of anxiety and depression.