Understanding Breast Reconstruction Preferences in African American Women

Recent research highlights that African American women who have undergone mastectomy prioritize complication risks and the aesthetic outcomes of breast reconstruction. The findings, published in the journal Plastic and Reconstructive Surgery, emphasize the importance of patient preferences in the reconstruction decision-making process.

Lead researcher from Memorial Sloan Kettering Cancer Center indicates that with the growing emphasis on shared decision-making in healthcare, it is vital to develop tools that capture patient treatment preferences. The study was conducted in collaboration with researchers from Duke University and aimed to improve communication between patients and healthcare providers.

The researchers utilized a method known as adaptive choice-based conjoint analysis (ACBC) to gather detailed insights into the individual preferences of women considering breast reconstruction. This interactive tool presented participants with information concerning the expected outcomes and risks associated with two primary reconstruction options: implant-based reconstruction and autologous reconstruction, which involves using tissue from the patient's own body.

The study surveyed 181 African American women either receiving treatment for breast cancer or opting for preventive mastectomy due to high genetic risk. Results indicated that the risk of major complications was the leading concern for these patients, influencing their preferences significantly, with an average importance rating of 26%. The aesthetic appearance of the reconstructed breast held a relative importance of 15%. Other considerations included the potential need for further surgeries, the implications of flap reconstruction on abdominal appearance, and recovery duration.

Following an evaluation of these factors, it was found that 85% of participants preferred implant-based reconstruction. Interestingly, women in better health and with fewer previous complications were more inclined towards this option. Additionally, those undergoing preventive mastectomy showed a higher preference for implants.

Conversely, 15% of the women preferred autologous reconstruction, with a notable portion citing the superior appearance of flap reconstruction compared to implants. Women opting for flap reconstruction were generally willing to accept a slightly higher risk of complications, provided they remained within certain thresholds.

This study is particularly significant as it is among the first to focus explicitly on the preferences of African American women regarding breast reconstruction. The findings suggest that while there are similarities in preferences between African American and white patients, there are nuanced differences in how these factors are prioritized.

Moreover, the research underlines the necessity for enhanced communication and shared decision-making, especially for populations that historically experience lower rates of engagement in their treatment choices. Two-thirds of participants reported finding the ACBC analytical exercise to be very useful in their decision-making process.

The authors conclude that actively engaging patients in discussing their values and preferences is crucial, particularly for historically marginalized groups. This approach could lead to improved healthcare experiences and outcomes.