Clarifying the Expectations of Patients Undergoing Implant Breast Reconstruction: A Qualitative Study

BACKGROUND: Unfulfilled expectations can lead to patient dissatisfaction with surgical outcomes. Understanding expectations allows surgeons to identify those patients who hold inaccurate expectations preoperatively, and to reset those expectations through focused preoperative education. The purpose of this study was to investigate preoperative expectations of women undergoing implant breast reconstruction. Identifying inaccurate or unfulfilled expectations is a critical step toward the advancement of preoperative education and subsequently improving patient satisfaction with surgical outcomes. METHODS: In-depth, open-ended interviews were conducted with 28 women undergoing implant breast reconstruction. The interviews were recorded and transcribed, and data were coded using standard qualitative techniques. RESULTS: Interviews ascertained that implant-based breast reconstruction patients may have inaccurate expectations regarding the results of their surgery despite having received standard preoperative teaching. Specifically, patients often had unclear expectations regarding the appearance and physical outcome of the reconstructed breast(s). Some patients were surprised by the "flatness" of the tissue expander immediately after its insertion. Most patients felt unprepared for the "unnatural" final appearance of the breast(s). Furthermore, they did not expect many of the physical outcomes, including loss of sensation, firmness of the reconstructed breast(s), and lack of movement of the reconstructed breast(s). Inaccurate expectations corresponded to areas of dissatisfaction highlighted by the patients in postoperative interviews. CONCLUSIONS: This study has important implications for preoperative education of women undergoing implant breast reconstruction. Physicians and nurses involved in the preoperative preparation process should take care to explore patients' expectations regarding the appearance, feel, sensation, and movement of reconstructed breasts to increase overall postoperative satisfaction.