Understanding decision-making for and against oncoplastic breast-conserving surgery as an alternative to a mastectomy in early breast cancer: UK ANTHEM qualitative study

Background:
Oncoplastic breast conserving surgery (OPBCS) may allow women with early breast cancer to avoid mastectomy, but many women undergo more extensive surgery even when breast conserving options are offered. The ANTHEM qualitative study aimed to explore factors influencing women’s surgical decision-making for and against OPBCS.

Methods:
Semi-structured interviews were conducted with a purposive sample of women who had received either OPBCS or mastectomy +/- immediate breast reconstruction (IBR) to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically.

Results:
Twenty-seven women from 12 centres were interviewed. Out of these, 12 had chosen OPBCS and 15 mastectomy +/- IBR, respectively. Overwhelmingly, the decisions were guided by their surgical teams. The decision-making for and against OPBCS was influenced by three key inter-related factors; perceptions of oncological safety, maintenance/restoration of femininity and practical issues. Oncological safety was paramount. Women who reported feeling reassured that OPBCS was oncologically safe were happy to choose this option. Those who were not reassured more likely to opted for mastectomy as a perceived ‘safer’ option. Most women wished to maintain/restore femininity with the offer of IBR essential to make mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern.

Conclusions:
Decision-making is complex and heavily influenced by the surgical team. High quality, accurate information about surgical options including appropriate reassurance about short- and long-term oncological safety of OPBCS is vital if women are to make fully informed decisions.