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Women Forgoing Reconstruction After Mastectomy Pleased

FRIDAY, Jan. 15, 2021 -- Most patients undergoing mastectomy alone, known as "going flat," are satisfied with their surgical outcome, according to a study published online Jan. 3 in the Annals of Surgical Oncology.

Jennifer L. Baker, M.D., from the University of California, Los Angeles, and colleagues conducted an online survey of 931 women who had a history of unilateral or bilateral mastectomy for treatment of breast cancer or elevated breast cancer risk without current breast mound reconstruction. Motivations and satisfaction were evaluated.

The researchers found that mastectomy alone was the first choice for 73.7 percent of the respondents, with 22 percent reporting "flat denial," or surgeons advising against or not offering the option of no reconstruction after mastectomy. Top reasons cited for going flat were desire for a faster recovery and avoidance of a foreign body placement. The overall mean scaled satisfaction score was 3.72 out of 5. A low level of surgeon support for the decision to go flat was the strongest predictor of a satisfaction score <3 (odds ratio [OR], 3.85). Respondents reporting a body mass index (BMI) of ≥30 kg/m2 (OR, 2.74) and those undergoing a unilateral procedure (OR, 1.99) had greater dissatisfaction, while greater satisfaction was associated with receiving adequate information about surgical options (OR, 0.48) and having a surgeon with a specialized breast surgery practice (OR, 0.56).

"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 postoperative appearance," a coauthor said in a statement.

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