Accurate self-predictions of future well-being after undergoing mastectomy both with and without immediate reconstruction contribute significantly to patients’ decision satisfaction and decision regret, a study published in JAMA Surgery has shown.

An important part of making a good treatment decision is to accurately predict future well-being. However, when considering immediate reconstruction after mastectomy, patients tend to overestimate the negative impact of no reconstruction and underestimate the positive impact of immediate reconstruction. Therefore, researchers sought to determine the accuracy of patients’ self-predictions of well-being and how those predictions influence satisfaction or regret with their decision.

For the study, researchers analyzed a cohort of 96 women undergoing mastectomy for stage I, II, or III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis — 54 in the mastectomy only group and 42 in the mastectomy with immediate reconstruction group. Of the 96 women, 69 (72%) had stage 0, I, or II disease; mean age was 53.9 years, 73 (76%) were white, 50 (52%) were college graduates, 54 (56%) were privately insured, and 31 (32%) had received adjuvant radiation.

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Domains measured included happiness (measured with Cantril Ladder) and quality of life; and satisfaction with breast, clothed and unclothed; sexual attractiveness, clothed and unclothed; breast numbness; and pain (measured with BreastQ single items). Preoperative predictions for the domains were obtained, and the domains were measured at 12 months. In addition, the Decision Regret Scale and Satisfaction With Decisions Scale were added to postoperative assessments.

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Patients who underwent mastectomy only underestimated their future well-being in all domains, with significant differences seen in mean predicted vs mean actual, respectively, in quality of life scores (68 vs 74) and satisfaction with breasts–clothed (2.4 vs 2.8). 

Future well-being was overestimated in all but 1 domain among patients who underwent mastectomy with reconstruction, with significant differences reported for satisfaction with breasts–unclothed (3.1 vs 2.6), sexual attractiveness–clothed (3.7 vs 3.3), and sexual attractiveness–unclothed (3.3 vs 2.3).

Numbness was greater than predicted in both groups: mastectomy only, 2.79 vs 3.52; mastectomy with reconstruction, 2.72 vs 3.56. Patients who were less happy or experienced greater pain also reported greater decision regret. 

The researchers concluded that inaccurate prediction of future well-being was associated with decision regret. Therefore, they suggest that addressing expectations about well-being should be a part of decision support regarding breast reconstruction for patients undergoing mastectomy.


Lee CN, Pignone MP, Deal AM, et al. Accuracy of predictions of patients with breast cancer of future well-being after immediate breast reconstruction [published online February 7, 2018]. JAMA Surgery. doi: 10.1001/jamasurg.2017.6112