A groundbreaking study published in the September issue of Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons, sheds new light on the critical factors that influence breast reconstruction preferences among African American women undergoing mastectomy. This research, spearheaded by Dr. Ronnie L. Shammas of Memorial Sloan Kettering Cancer Center and senior author Dr. Clara N. Lee from the University of North Carolina, offers nuanced insight into how risk perceptions and aesthetic outcomes interplay in treatment decisions within this historically underrepresented population.
The study employs an innovative methodological approach known as adaptive choice-based conjoint (ACBC) analysis, a sophisticated tool designed to capture the complex, individualized decision-making processes of patients by quantifying the trade-offs they are willing to make when considering breast reconstruction options. Unlike traditional surveys, ACBC enables the dynamic elicitation of patient preferences by presenting varied scenarios, thus providing a realistic simulation of clinical decision-making.
The participants, comprising 181 African American women either receiving mastectomy for breast cancer treatment or for preventive reasons due to elevated genetic risk, were exposed to detailed comparative information regarding implant-based reconstruction versus autologous reconstruction. The latter procedure entails the use of a tissue flap — typically harvested from the abdomen — to reconstruct the breast, introducing considerations such as longer recovery, potential abdominal morbidity, and distinct complication profiles.
One of the pillar findings revealed that the risk of major postoperative complications wielded the most substantial influence on patient preferences, accounting for 26% of their decision weight. This statistically significant priority underscores the acute sensitivity patients have toward the safety and viability of reconstructive surgery. Following this, the aesthetic outcome—the anticipated appearance of the reconstructed breast—held a 15% relative importance, affirming the critical role of cosmetic satisfaction alongside safety concerns.
Importantly, the ACBC model integrated actual patient photographs demonstrating post-surgical outcomes, including scarring patterns and breast contour, thereby ensuring that participants’ preferences were grounded in a realistic visualization of results rather than abstract descriptions. This multimedia approach enhanced the ecological validity of the findings, affording participants a more informed basis for decision-making.
The study distinguished itself by quantifying tolerance thresholds for increased risk. Women opting for the autologous flap reconstruction cohort exhibited a willingness to accept an 8% elevation in the risk of major complications and a 6% increase in abdominal function detriment compared to implant options. These insights illuminate the nuanced balance patients strike when prioritizing aesthetic outcomes over potential morbidities. Conversely, women for whom these risk thresholds were unacceptable leaned decisively toward implant-based reconstruction.
A robust majority—85%—favored implant-based reconstruction, a preference significantly associated with better preoperative health status and absence of previous surgical complications. Furthermore, patients undergoing prophylactic mastectomy, who may perceive a slightly different risk-benefit calculus due to the preventive nature of their surgery, showed a heightened inclination toward implants.
This investigation importantly addresses a critical gap in the literature, focusing on a demographic traditionally underserved in reconstructive surgery research. Prior studies suggest that African American women report disproportionally lower rates of shared decision-making engagement, a disparity this study directly confronts by advocating for purposeful elicitation of patient values through tools like ACBC.
Shared decision-making, a cornerstone of contemporary medical ethics, requires integrating patient values into clinical recommendations, especially when treatment modalities offer no definitive superiority. The study authors emphasize that tools such as ACBC can bridge communication barriers and empower patients, fostering decisions tightly aligned with personal preferences and life circumstances.
Moreover, comparative analysis with predominantly White cohorts indicates largely parallel considerations across racial groups regarding reconstruction priorities, with variations mostly in the relative weight assigned to specific factors. This finding suggests that systemic factors rather than fundamental preference differences may drive disparities in outcomes and satisfaction within breast reconstruction.
Lead investigator Dr. Shammas highlights that effective patient engagement is especially vital for historically marginalized populations, who often experience disparities in healthcare communication and outcomes. The study advocates for clinicians to actively solicit patient values and preferences, recognizing that treating the patient holistically involves more than clinical indicators—it mandates understanding individual priorities and the psychosocial context of breast reconstruction.
The implications of these findings extend beyond immediate clinical practice, pointing to the need for integrating advanced preference-elicitation tools in surgical consultation workflows. Incorporating patient-centric data collection can refine preoperative counseling, support insurance and policy frameworks by emphasizing patient autonomy, and potentially improve surgical outcomes through enhanced alignment of treatment choice and patient goals.
This research, published by Wolters Kluwer under the auspices of the ASPS, not only elucidates the preferences of African American women but also advances the methodology of patient-centered outcomes research. By quantifying and respecting the trade-offs patients consider, the study pioneers pathways toward equitable and personalized breast cancer care, contributing to a future where reconstructive choices are truly reflective of patient aspirations and concerns.
Subject of Research: Breast Reconstruction Preferences among African American Women Undergoing Mastectomy
Article Title: Preferences for Care among African American Women Considering Postmastectomy Breast Reconstruction
News Publication Date: August 28, 2025
Web References:
https://journals.lww.com/plasreconsurg/fulltext/2025/09000/preferences_for_care_among_african_american_women.2.aspx
http://journals.lww.com/plasreconsurg/
http://www.plasticsurgery.org/
https://wolterskluwer.com/
Keywords: Breast cancer, breast reconstruction, African American patients, adaptive choice-based conjoint analysis, shared decision-making, implant reconstruction, autologous reconstruction, postoperative complications, patient preferences, surgical outcomes
Tags: adaptive choice-based conjoint analysisaesthetic outcomes in surgical decisionsbreast reconstruction preferences among African American womendecision-making in cancer treatmentfactors influencing breast surgery choicesimplant-based versus autologous reconstructionmastectomy treatment optionsMemorial Sloan Kettering Cancer Center researchpatient-centered approaches in healthcarequalitative research in plastic surgeryrisk perceptions in breast reconstructionunderrepresented populations in healthcare
