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Does The Mind Get What The Mind Expects? Patient Expectations And Satisfaction in Breast Reconstructive Surgery: A Pilot Study.
Shantanu N. Razdan, MD, MSPH1, Amie M. Scott, MPH1, Stefan Cano, PhD2, Peter G. Cordeiro, MD1, Andrea L. Pusic, MD, MHS1, Colleen M. McCarthy, MD, MS1.
1Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Peninsula College of Medicine & Dentistry, Plymouth, United Kingdom.

 Purpose: Patient’s pre-operative expectations are known to play an important role in patient’s perception of the outcome of their surgery. The aim of this study was to evaluate the effect of pre-operative patient expectations on patient-reported outcomes following breast reconstructive surgery.
 
Methods: Women who consented to undergo post-mastectomy reconstruction at a single cancer center completed the ‘Breast-Q: Expectations Module’ prior to surgery. Patients were subsequently categorized as having low, realistic or high pre-operative expectations regarding the outcome of their breast reconstruction. Following completion of reconstruction, women then completed ‘Breast-Q: Reconstruction Module’. Pre-operative expectation scores were statistically correlated with scores on the Breast-Q outcomes scales i.e. satisfaction with breasts, satisfaction with outcome, psychosocial well-being and sexual well-being.
 
Results: Complete data was available for 166 patients.  Overall, low pre-operative expectations were consistently correlated with poor patient-reported outcomes. Patients with high expectations reported better outcomes than those with low expectations and mostly higher than those with realistic expectations. For example, patients who had high pre-operative expectations regarding their psychosocial and sexual well-being reported higher post-operative well-being than even those who had realistic pre-operative expectations (p<0.05 and p<0.05, respectively).
 
Conclusion:  Low pre-operative expectations may be a risk factor for post-operative dissatisfaction.  Realistic or high pre-operative expectations may lead to higher patient satisfaction.  Further studies are needed to: i) better quantify the relationship between patients’ expectations and their perception of outcome; and, ii) to determine whether pre-operative expectations can be modified to produce long-term satisfaction.


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