Choosing reconstruction after mastectomy: a qualitative analysis.

PURPOSE/OBJECTIVES: To describe women's perspectives on factors that influenced their decision to have reconstructive surgery after a breast cancer diagnosis. DESIGN: Exploratory, descriptive, qualitative study. SETTING: A comprehensive cancer center in an urban setting. SAMPLE: Eleven women who underwent mastectomy and reconstruction. Six participants had autologous transverse rectus abdominis musculocutaneous-flap reconstruction, four had saline implants, and one had a silicone implant. All but one reconstruction was performed at the time of mastectomy. METHODS: Open-ended, face-to-face interviews using an interview guide were conducted within one month of reconstruction. One to two follow-up interviews were conducted approximately six months later. MAIN RESEARCH VARIABLES: Decision making about reconstruction, perceptions of information needs and sources, sources of support, and factors important to decision making. FINDINGS: The main theme identified was Getting My Life Back. The participants described this in terms of the themes of Information Seeking, Talking It Over, and Seeking Normality. The interactive skills of the healthcare provider played an important role in the women's decision making. CONCLUSIONS: Reconstruction minimized the negative consequences of breast cancer and its treatment for the women in the study. The decision-making process was aimed at getting the person's life back as close to what it was before the diagnosis as possible or improving it. The three themes of decision making are interactive in nature, with participants returning to information Seeking and Talking It Over as necessary to increasing their understanding and clarifying their "normality goals. IMPLICATIONS FOR NURSING PRACTICE: Healthcare professionals should determine how a woman wants to participate in decision making as well as the kind, amount, and sources of information the individual with breast cancer wants to have to make her decisions. Healthcare providers are key sources of information about treatment options, and they are critical to patient satisfaction with the decision-making process and with the final results of the surgical procedure. Family members, friends, and other women with breast cancer play a crucial role in talking it over.