Breast Cancer Patient Awareness and Reasons for Foregoing Breast Reconstruction. Early Findings From the ROSE (Breast Cancer and Reconstruction Outcome Survey) Study.

Abstract

Breast reconstruction (BR) can improve the quality of life following breast cancer surgery, yet some patients forgo the option. Research has focused mainly on system-level barriers, while patient-reported reasons for declining reconstruction have been understudied. The ROSE (Breast Cancer and Reconstruction Outcome Survey) study is an ongoing prospective cohort study at an academic hospital. Women ≥18 years undergoing lumpectomy or mastectomy with or without BR were included and classified by reconstruction status. Clinical data were collected, and patients who did not undergo reconstruction (no-BR group) completed a "Reasons for No Reconstruction" survey. Quantitative items were statistically compared between the BR and no-BR groups, and open-text responses underwent thematic analysis. Of the 349 participants enrolled, 199 (57%) did not undergo BR, and of these, 179 (90%) completed a decision-making survey. Compared with BR patients, the no-BR cohort was older (mean: 62.6 vs. 49.0 y, P<0.0001) and more often received adjuvant radiation (76% vs. 36%, P<0.0001). Of the 179 no-BR patients, 32% recalled discussing reconstruction with their breast surgeon, 13% were offered a plastic surgery consultation, and 3% attended a consult. The top reasons for declining BR were acceptance of the appearance (48%), belief that BR was not essential to health (34%), and feeling they had enough intervention (16%). Thematic analysis identified gaps in treatment information, perceived ineligibility after lumpectomy, and personal factors such as age and a desire to avoid further treatment as reasons for no BR. Over half of breast cancer patients declined breast reconstruction after surgery. Decisions were influenced by patient preference, physician referral, and information barriers. These new data may support informed, patient-centered care.