Bochtsou Valentini, Effraimidou Eleni I, Samakouri Maria, Plakias Spyridon, Arvaniti Aikaterini
Department of Psychiatry, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
First Surgical Department, Faculty of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece.
Healthcare (Basel). 2025 May 30;13(11):1307. doi: 10.3390/healthcare13111307.
: Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. : A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. : Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. : BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes.
乳房切除术后的乳房重建（BR）通过提供生理和心理益处，在癌症后护理中发挥着关键作用。尽管技术和共同决策（SDM）取得了进展，但BR的接受情况仍然不一致。本系统评价旨在综合关于影响接受乳腺癌乳房切除术的女性BR决策的客观（医学和社会经济）和主观（心理和个人）因素的证据。
在PubMed、ScienceDirect、OVID和谷歌学术上进行了系统检索，识别2013年1月至2024年7月25日发表的同行评审研究。符合条件的研究考察了接受治疗性乳房切除术的女性BR决策的决定因素，排除非患者利益相关者的观点和决策后的结果。使用多样研究质量评估（QuADS）工具评估偏倚风险和研究质量。本评价在PROSPERO（CRD42023456198）注册，并遵循PRISMA指南。
来自16个国家的27项研究共994528名参与者符合纳入标准。客观因素包括年龄、合并症、保险覆盖范围、医生建议和医疗服务可及性。主观因素包括对身体形象的担忧、自尊、对复发的恐惧和情绪准备情况。年轻、有私人保险和医生积极咨询与BR接受率增加相关，而年龄较大、信息不足以及经济或后勤障碍则降低了接受率。不同医疗系统存在地区差异。
BR决策受复杂、相互关联的临床、心理和系统因素影响。整合SDM工具、加强患者教育以及解决医疗不平等问题对于支持明智和公平的BR决策至关重要。未来研究应优先进行纵向研究和政策干预，以改善BR服务的可及性和患者对BR结果的满意度。
