Abstract P4-12-08: Patients' and surgeons' experiences after failed breast reconstruction: A qualitative study
Authors: Kouwenberg CA , Hoogdalem LE , Gopie JP , Tibben A , Mureau MA , Ismail SY , Kranenburg LW 
Published: May 2019

Abstract
Background: Breast cancer reconstructive surgery is supposed to contribute to patients' body image and quality of life. However, complications after autologous breast reconstruction (A-BR) and implant-based breast reconstruction (I-BR) do occur in approximately 40% of the women, and may even lead to complete failure in rare cases. This study explores both patients' and surgeons' experiences after failed breast reconstruction. Increased knowledge in this field could help to improve not only the care for women with failed breast cancer reconstructive surgery but may also help to guide professionals in dealing with such failures.
Methods: Patients with reconstructive failure form a large multicenter cohort study and participating plastic surgeons were invited to participate in this study. A topic list consisting of ten topics served as a general outline of a semi-structured interview on their experiences with the reconstructive failure, lasting about one hour. The interview data were transcribed and after that analyzed according to the principles of grounded theory by two researchers independently of each other. Data were coded in NVivo software. Next, data were discussed in a larger team, thereby moving back and forth between data and emerging theory.
Results: Fourteen patients with a failed I-BR, four patients with failed A-BR and four plastic surgeons participated in this study. Three main categories emerged from the data: personal experiences, the motivation for a redo of the failed reconstructive surgery and patient-doctor communication. With regard to personal experiences, a main patient category was the importance of being (appreciated as) a person as a whole, in his/her specific context (versus focusing on reconstructive technique). This in contrast to the surgeons, for whom it did matter whether the failure concerned an I-BR or A-BR. The latter was perceived as more intense. Some took it as a personal failure, leading to insecurity and feelings of regret towards the patient. This was especially true if they felt a strong bond with that particular patient. With regard to motivation for a redo of the failed reconstructive surgery, both patients and surgeons emphasized the importance of shared decision making. Nevertheless, patients seemed to remain more ambivalent than surgeons about pursuing additional reconstruction after failure. Finally, regarding patient-doctor communication, we found that surgeons were more distant or reflective on these matters, whereas patients expressed their experiences in a more emotional way. Patients expressed a desire to be seen and treated as an unique individual. Experiencing trustfulness, sincerity and empathy from the surgeon in discussing the failure were highly valued.
Discussion: Implementing the results of this study in clinical practice may facilitate coping with the distressing or even traumatic event of failed breast reconstruction, in both patients and surgeons.
Citation Format: Kouwenberg CA, Hoogdalem LE, Gopie JP, Tibben A, Mureau MA, Ismail SY, Kranenburg LW. Patients' and surgeons' experiences after failed breast reconstruction: A qualitative study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-08.