Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.
Population Health sciences, Bristol medical School, Bristol, UK.
Br J Surg. 2024 Jun 12;111(6). doi: 10.1093/bjs/znae133.
Oncoplastic breast-conserving surgery may allow women with early breast cancer to avoid a mastectomy, but many women undergo more extensive surgery, even when breast-conserving options are offered. The aim of the ANTHEM qualitative study was to explore factors influencing women's surgical decision-making for and against oncoplastic breast-conserving surgery.
Semi-structured interviews were conducted with a purposive sample of women who had received either oncoplastic breast-conserving surgery or a mastectomy with or without immediate breast reconstruction to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically. Trial registration number: ISRCTN18238549.
A total of 27 women from 12 centres were interviewed. Out of these, 12 had chosen oncoplastic breast-conserving surgery and 15 had chosen a mastectomy with or without immediate breast reconstruction. Overwhelmingly, women's decisions were guided by their surgical teams. Decision-making for and against oncoplastic breast-conserving surgery was influenced by three key inter-related factors: perceptions of oncological safety; the importance of maintaining/restoring femininity and body image; and practical issues. Oncological safety was paramount. Women who reported feeling reassured that oncoplastic breast-conserving surgery was oncologically safe were happy to choose this option. Those who were not reassured were more likely to opt for a mastectomy, as a perceived 'safer' option. Most women wished to maintain/restore femininity, with the offer of immediate breast reconstruction essential to make a mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern.
Decision-making is complex and heavily influenced by the surgical team. High-quality, accurate information about surgical options, including appropriate reassurance about the short- and long-term oncological safety of oncoplastic breast-conserving surgery is vital if women are to make fully informed decisions.
肿瘤整形保乳手术可以使早期乳腺癌女性避免接受乳房切除术，但许多女性接受了更广泛的手术，即使提供了保乳选择。ANTHEM 定性研究的目的是探讨影响女性接受或拒绝肿瘤整形保乳手术的手术决策的因素。
对接受肿瘤整形保乳手术或乳房切除术（伴或不伴即刻乳房重建）的女性进行了一项有目的的样本的半结构化访谈，以探讨其选择手术的理由。对访谈进行了逐字转录，并进行了主题分析。试验注册号：ISRCTN8238549。
共采访了来自 12 个中心的 27 名女性。其中 12 人选择了肿瘤整形保乳手术，15 人选择了乳房切除术（伴或不伴即刻乳房重建）。女性的决策主要受到其手术团队的影响。支持和反对肿瘤整形保乳手术的决策受到三个关键的相互关联的因素的影响：对肿瘤学安全性的看法；保持/恢复女性气质和身体形象的重要性；以及实际问题。肿瘤学安全性至关重要。那些感到肿瘤整形保乳手术在肿瘤学上是安全的女性会很高兴选择这种选择。那些没有得到保证的女性更有可能选择乳房切除术，因为这是一种被认为更“安全”的选择。大多数女性希望保持/恢复女性气质，提供即刻乳房重建对接受乳房切除术至关重要。手术的实际问题（如手术的规模）则是次要问题。
决策是复杂的，受到手术团队的严重影响。如果要使女性做出完全知情的决策，就必须提供有关手术选择的高质量、准确信息，包括对肿瘤整形保乳手术的短期和长期肿瘤学安全性的适当保证。
