Psychological perspectives on breast reconstruction: patient reported outcomes and effects of complications

Abstract

The overall aim of the thesis was to increase the understanding of women’s experiences of breast reconstruction. Women undergoing mastectomy and breast reconstruction participated in paper I, II and IV. Paper I was a qualitative study that examined women’s lived experiences with implant loss due to complications following immediate breast reconstruction (IBR). Paper II was a retrospective, cross-sectional study that aimed to compare patient reported outcomes, primarily health related quality of life (HRQoL) and patient satisfaction, among women who had experienced implant loss, comparing the outcomes to a cohort of women who had undergone IBR without implant loss. Paper III systematically reviewed available scores that enable interpretation of validated patient reported outcome measures (PROMs). Paper IV was a validation study with the aim to translate and examine the psychometric properties of an instrument developed to assess a main dimension of body image. The results revealed that implant loss following IBR was a challenging experience with negative implications on the participants’ psychological well-being. Women who experienced implant loss had overall worse outcomes compared to those who did not experienced implant loss. Paper III showed that normative data and minimally important differences (MIDs) only were available for one instrument (BREAST-Q) developed for women undergoing breast reconstruction. The quality of evidence was considered low for both outcomes. Paper IV revealed overall adequate psychometric properties for a three-factor structure for the Appearance Schemas Inventory- Revised (ASI-R), unique to a Swedish population of women undergoing mastectomy and breast reconstruction. In conclusion, the thesis increases the understanding about women’s experiences of implant loss and highlights how the assessment of women’s experiences of breast reconstruction can be developed, which has implications for both future research and clinical practice.