Patients often mispredict well-being after mastectomy

(HealthDay)—Adult women undergoing mastectomy underestimate future well-being after mastectomy alone and overestimate well-being after reconstruction, according to a study published online Feb. 7 in JAMA Surgery.

Clara Nan-hi Lee, M.D., M.P.P., from The Ohio State University in Columbus, and colleagues conducted a prospective cohort survey study involving adult women undergoing mastectomy for stage 1, 2, or 3 invasive ductal or lobular breast cancer; ductal carcinoma in situ; or prophylaxis. Data were included for a final cohort of 96 women: 42 had had reconstruction and 54 had not had reconstruction.

The researchers found that there was underestimation of future well-being in all domains for patients having mastectomy without reconstruction. Significant differences were seen for quality of life scores (mean predicted versus actual: 68 versus 74) and satisfaction with breasts-clothed (mean predicted versus actual: 2.4 versus 2.8). Future well-being was overestimated in all but one domain for patients undergoing mastectomy with reconstruction. Significant differences were seen for satisfaction with breasts-unclothed (mean predicted versus actual: 3.1 versus 2.6), sexual attractiveness-clothed (mean predicted versus actual: 3.7 versus 3.3), and sexual attractiveness-unclothed (mean predicted versus actual: 3.3 versus 2.3). More numbness than predicted was experienced by both groups. Greater regret was noted for patients who were less happy or had greater pain than predicted.

"Decision support for breast reconstruction should address expectations about well-being," the authors write.

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