J Korean Acad Nurs.  2016 Dec;46(6):894-904. 10.4040/jkan.2016.46.6.894.

Decision Making Experience on Breast Reconstruction for Women with Breast Cancer

• Yi M
• Joung WJ
• Park EY
• Kwon EJ
• Kim H
• Seo JY

• KMID: 2424660
• DOI: http://doi.org/10.4040/jkan.2016.46.6.894

Abstract

PURPOSE
The purpose of this study was to explore decision making experiences of Korean women with breast cancer who underwent breast reconstruction with/after a mastectomy.
METHODS
Data were collected during 2015-2016 through individual in-depth interviews with 10 women who had both mastectomy and breast reconstruction, and analyzed using phenomenological method to identify essential themes on experiences of making a decision to have breast reconstruction.
RESULTS
Five theme clusters emerged. First, "expected loss of sexuality and discovery of autonomy" illustrates various aims of breast reconstruction. Second, "holding tight to the reputation of doctors amid uncertainty" specifies the importance of a trust relationship with their physician despite a lack of information. Third, "family members to step back in position" describes support or opposition from family members in the decision making process. Fourth, "bewilderment due to the paradox of appearance-oriented views" illustrates paradoxical environment, resulting in confusion and anger. Lastly, "decision to be made quickly with limited time to oneself" describes the crazy whirling process of decision making.
CONCLUSION
Findings highlight aims, worries, barriers, and facilitators that women with breast cancer experience when making a decision about breast reconstruction. Deciding on breast reconstruction was not only a burden for women in a state of shock with a diagnosis of breast cancer, but also an opportunity to decide to integrate their body, femininity, and self which might be wounded from a mastectomy. These findings will help oncology professionals provide effective educational counselling before the operation to promote higher satisfaction after the operation.

Keyword

Breast Neoplasms; Mammoplasty; Decision Making; Qualitative Research; Women

MeSH Terms

Adult
Breast Neoplasms/*psychology/surgery
*Decision Making
Female
Humans
Mammaplasty
Middle Aged
Patient Satisfaction
Qualitative Research
Self Efficacy
Sexuality
Social Support
Socioeconomic Factors
Surveys and Questionnaires
Uncertainty

Reference

1. National Cancer Information Center. Cancer information service [Internet]. Goyang: Author;2016. cited 2016 January 20. Available from:http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_100100000000.

2. Chung IY, Kang E, Yang EJ, Lim JY, Kim EK, Kim HA, et al. Survey of psychosocial problems facing breast cancer survivors after undergoing a mastectomy and their awareness of breast reconstruction. J Breast Cancer. 2011; 14:Suppl 1. S70–S76. DOI: 10.4048/jbc.2011.14.S.S70.

3. Piot-Ziegler C, Sassi ML, Raffoul W, Delaloye JF. Mastectomy, body deconstruction, and impact on identity: A qualitative study. Br J Health Psychol. 2010; 15(Pt 3):479–510. DOI: 10.1348/135910709x472174.

4. Furlan VLA, Sabino Neto M, Abla LEF, Oliveira CJR, Lima ACD, Ruiz BFDO, et al. Quality of life and self-esteem after mastectomy in patients who did or did not undergo breast reconstruction. Revista Brasileira de Cirurgia Plástica. 2013; 28(2):264–269. DOI: 10.1590/S1983-51752013000200016.

5. Nam S, Park S, Lee DW, Song SY, Park HS, Kim SI, et al. Clinical outcome of immediate breast reconstruction after mastectomy for breast cancer. J Breast Dis. 2014; 2(2):44–50. DOI: 10.14449/jbd.2014.2.44.

6. Nissen MJ, Swenson KK, Kind EA. Quality of life after postmastectomy breast reconstruction. Oncol Nurs Forum. 2002; 29(3):547–553. DOI: 10.1188/02.onf.547-553.

7. Fernández-Delgado J, López-Pedraza MJ, Blasco JA, Andradas-Aragones E, Sánchez-Méndez JI, Sordo-Miralles G, et al. Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Ann Oncol. 2008; 19(8):1430–1434. DOI: 10.1093/annonc/mdn153.

8. Kang HJ, Kim SW, Noh DY, Youn YK, Oh SK, Choe KJ, et al. Immediate breast reconstruction after a mastectomy for breast cancer. J Korean Surg Soc. 2000; 59(5):584–589.

9. Ceradini DJ, Levine JP. Breast cancer reconstruction: More than skin deep. Prim Psychiatry. 2008; 15(10):72–80.

10. Korean Breast Cancer Society. Breast cancer facts & figures [Internet]. Seoul: Author;2015. cited 2016 June 10. Available from:http://www.kbcs.or.kr/journal/file/2015_Breast_Cancer_Facts_and_Figures_updated.pdf.

11. Lee CN, Hultman CS, Sepucha K. What are patients’ goals and concerns about breast reconstruction after mastectomy? Ann Plast Surg. 2010; 64(5):567–569. DOI: 10.1097/SAP.0b013e3181bffc9b.

12. Wolf L. The information needs of women who have undergone breast reconstruction. Part I: Decision-making and sources of information. Eur J Oncol Nurs. 2004; 8(3):211–223. DOI: 10.1016/j.ejon.2003.12.012.

13. Wolf L. The information needs of women who have undergone breast reconstruction. Part II: Information giving and content of information. Eur J Oncol Nurs. 2004; 8(4):315–324. DOI: 10.1016/j.ejon.2003.12.013.

14. Sheehan J, Sherman KA, Lam T, Boyages J. Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology. 2007; 16(4):342–351. DOI: 10.1002/pon.1067.

15. Nissen MJ, Swenson KK, Kind EA. Quality of life after postmastectomy breast reconstruction. Oncol Nurs Forum. 2002; 29(3):547–553. DOI: 10.1188/02.onf.547-553.

16. Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: A prospective, multicenter study. Plast Reconstr Surg. 2003; 111(3):1060–1068. DOI: 10.1097/01.prs.0000046249.33122.76.

17. Finlay L. Ambiguous encounters: A relational approach to phenomenological research. Indo-Pac J Phenomenol. 2009; 9(1):1–17. DOI: 10.1080/20797222.2009.11433983.

18. Patton MQ. Qualitative research methods. Newbury Park, CA: Sage;1980. p. 1–381.

19. Colaizzi PF. Psychological research as the phenomenologist views it. In : Valle RS, King M, editors. Existential-phenomenological alternatives for psychology. New York, NY: Oxford University Press;1978. p. 48–71.

20. Guba EG, Lincoln YS. Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco, CA: Jossey-Bass;1981. p. 1–444.

21. Fang SY, Balneaves LG, Shu BC. “A struggle between vanity and life”: The experience of receiving breast reconstruction in women of Taiwan. Cancer Nurs. 2010; 33(5):E1–E11. DOI: 10.1097/NCC.0b013e3181d1c853.

22. Rubin LR. “Does that make me a woman?”: Breast cancer, mastectomy, and breast reconstruction decisions among sexual minority women. Psychol Women Q. 2011; 35(3):401–414. DOI: 10.1177/0361684310395606.

23. Sandham C, Harcourt D. Partner experiences of breast reconstruction post mastectomy. Eur J Oncol Nurs. 2007; 11(1):66–73. DOI: 10.1016/j.ejon.2006.05.004.

24. Osuch JR, Silk K, Price C, Barlow J, Miller K, Hernick A, et al. A historical perspective on breast cancer activism in the United States: From education and support to partnership in scientific research. J Womens Health (Larchmt). 2012; 21(3):355–362. DOI: 10.1089/jwh.2011.2862.