Nearly three-quarters of women surveyed for a study led by researchers at the UCLA Jonsson Comprehensive Cancer Center were satisfied with their decision to forgo reconstruction surgery after a mastectomy.

Of the 931 survey participants who had unilateral or bilateral mastectomies and did not undergo breast mound reconstruction, 74% were satisfied with their outcome and 22% experienced “flat denial,” where the procedure was not initially offered, the surgeon did not support the patient’s decision or intentionally left additional skin in case she changed her mind.

The results challenge past studies that concluded that patients who choose not to undergo breast reconstruction tend to have a poorer quality of life compared with those who do have the surgery, according to UCLA.

Many of the women surveyed told researchers that they believed reconstruction wasn’t important for their body image, and they wanted to recover faster and avoid a foreign body placement.

“Undergoing a mastectomy with or without reconstruction is often a very personal choice,” said Dr. Deanna Attai, an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, and senior author of the study.

“We found that for a subset of women, `going flat’ is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their post-operative appearance,” Attai said.

Researchers believe the previous studies that suggested women without reconstruction surgery have poorer qualities of life used survey tools that were biased toward reconstruction. To avoid that bias, Attai and her team partnered with patient advocates to create a unique survey to assess women’s reasons for forgoing reconstruction surgery, their satisfaction with the decision and factors associated with the satisfaction.

While a majority of those surveyed were satisfied with their decision, 27% said they were not satisfied with their flat chest appearance.

“Some patients were told that excess skin was intentionally left — despite a preoperative agreement to perform a flat chest wall closure — for use in future reconstruction, in case the patient changed her mind,” Attai said. “We were surprised that some women had to struggle to receive the procedure that they desired.”

Attai noted that some surgeons may hesitate to recommend women forgo reconstruction surgery because they are less confident that they’ll be able to provide cosmetically acceptable results.

“We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option,” Attai said. “We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision.”

The study, which was published Sunday in the Journal Annals of Surgical Oncology, was co-authored by Drs. Jennifer Baker, Carlie Thompson, Minna Lee and Maggie DiNome of UCLA; Dr. Don Dizon of Brown University and the Lidespan Cancer Institute; and Drs. Cachet Wenziger and Elani Streja of the UC Irvine School of Medicine.

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