Perception of Breast Reconstruction After Mastectomy for Cancer. Experience of the General Surgery Department of the Military Hospital Avicenne in Marrakesh

Breast cancer, and particularly its treatment by mastectomy, is a physical and psychological trauma for woman patient. It emphasizes the need for breast reconstruction (BR) surgery for its psychosocial benefits, hence the interest in evaluating the perception and satisfaction of BR in patients treated by mastectomy. The present work is a retrospective study conducted in General Surgery Department of the Military Hospital Avicenne in Marrakesh. The aim of the study is to explore the satisfaction and health status of patients who received or refused reconstruction after BC surgery using the BREAST-Q questionnaire and further, investigate the factors influencing the patients’ satisfaction and health- related Quality of life. This study enrolled 201 women who underwent Mastectomy for cancer in our department from January 2021 to December 2022. The mean age of the patients was 49.14 (± 10.17) years. Palpation of a nodule was the most frequent reason for discovery (89.5%). Only 51 (25.4%) of our patients had BR. The average age of this category was 44.74 (± 6.78) years, of which 62.7% were married and 19.6% were single. BR was proposed to all patients. The reconstruction techniques used in our study were permanent prosthesis (64.70%), expanding prosthesis (23.52%), Latissimus Dorsi flap (5.9%) and breast reduction (5.9%). Only 25.4% accepted BR (Group 1). The main motivations were the desire to regain their femininity and feel good about themselves (100%), the wish to feel whole and to regain balance (94%), the desire to regain a normal sexual and marital life (88%), the hope to forget everything that reminds one of cancer (24%) and finally, the influence of their husband (47%). BR was refused by 74.6% of patients (Group 2). The main reasons for refusal were age (71%), religious beliefs (26%), high cost (70%), fear of complications (24%) and fear of additional surgery (26%). We used the BREAST-Q questionnaire as a tool to assess patient quality of life and satisfaction with BR. The evaluation modules were satisfaction with the breast, social satisfaction, sexual satisfaction, satisfaction with the surgeon, paramedical and administrative staff. With a mean score of 79.14 and extremes ranging from 40 to 100, patients who underwent BR surgery were globally satisfied psychologically, socially and sexually. The rate of BR after mastectomy is low compared to the literature, which underlines the need to give special attention to the promotion in our country of post-mastectomy BR.