Abstract P4-09-04: When discussing breast reconstruction, do psychosocial characteristics influence which surgical options patients remember?
Authors: Wang Haoqi , Liu Jun , Bordes Mary Catherine , Chopra Deepti , Reece Gregory P , Markey Mia K , Hoffman Aubri S 
Published: March 2022

Abstract
Introduction Although decisions about breast reconstruction surgery include patients’ perspectives, little is known about which options patients recall discussing and how their psychosocial factors influence their recall. The purpose of this study was to explore whether psychosocial factors were associated with the breast reconstruction options a patient remembers discussing with their reconstructive surgeon, controlling for medical factors that impact surgical decision-making. Material and methods From 2011 to 2014, we recruited English-speaking adults whose legal sex was female who had an appointment at The University of Texas MD Anderson Cancer Center to discuss breast reconstruction. After the clinical consultation, participants indicated which reconstruction procedures they remembered discussing with their reconstructive surgeon (choose all that apply): (1) implant-based, (2) tissue-based, (3) combination of implant and tissue. Analyses focused on three groups: participants who remembered (a) only an implant-based option being discussed; (b) only a tissue-based option being discussed; and (c) implant-based, tissue-based, and combination options being discussed. We investigated the association between which reconstruction option(s) a participant remembered discussing with her reconstructive surgeon and her body image investment (Appearance Schemas Inventory-Revised (ASI-R)), body image (Body Image Scale (BIS)), and overall psychological distress (Brief Symptom Inventory-18 (BSI-18)), considering participant age and Body Mass Index (BMI). Multiple multinomial logistic regression models were used to investigate the associations of participant factors with the reconstruction options they remembered discussing with their surgeon. Akaike information criterion (AIC) was applied to select the best-fitting multivariable model. Results Out of 306 participants,138 participants remembered discussing only implant-based reconstruction; 118 participants remembered discussing only tissue-based reconstruction; and 50 participants remembered discussing implant-based, tissue-based, and combination options. The majority of participants were Caucasian (74.8%) and non-Hispanic (75.2%). BMI, body image investment, and body image were identified as associated with remembering different reconstruction options being discussed and were included in the multiple multinomial logistic regression model. Greater body image investment (i.e., higher ASI-R composite score) was significantly associated with higher odds of remembering discussing only implant-based reconstruction as compared to remembering discussing only tissue-based reconstruction, adjusted for the other factors in the model (adjusted odds ratio [OR] = 1.70, 95% CI = 1.04-2.79, p-value = 0.035). Greater body image dissatisfaction or concerns (i.e., higher BIS score) was associated with higher odds of remembering discussing only tissue-based reconstruction compared to remembering discussing only implant-based reconstruction, adjusted for the other factors in the model (adjusted OR = 1.04, 95% CI = 1.00-1.08, p-value = 0.045). Conclusion Our findings indicate that even when adjusted for BMI, patients with higher body image investment may be more likely to remember discussions about implant-based reconstruction, and patients with greater body image dissatisfaction may be more likely to remember discussions about tissue-based reconstruction. Tailored counseling approaches may be recommended to ensure all patients equally attend to and consider all medically-relevant options when discussing breast reconstruction surgery.
Citation Format: Haoqi Wang, Jun Liu, Mary Catherine Bordes, Deepti Chopra, Gregory P Reece, Mia K Markey, Aubri S Hoffman. When discussing breast reconstruction, do psychosocial characteristics influence which surgical options patients remember? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-04.