An outdated or missing telephone may not be readily available.
Enhanced preoperative counseling by surgeons can reduce postoperative decision regret in plastic surgery, particularly in breast reconstruction. Identifying factors contributing to decision regret is essential for enhancing patient satisfaction. Utilizing shared decision-making is crucial in utilizing these strategies. The distinct psychological challenges arising from variations in medical necessity underscore the need for further investigation.
Studies have shown that patients who receive thorough preoperative counseling from their surgeons are less likely to experience regret over their decisions following plastic surgery, such as breast reconstruction. By identifying the factors that lead to decision regret, doctors can better tailor their counseling sessions to meet the individual needs of each patient, ultimately leading to higher satisfaction rates. Shared decision-making between patients and surgeons plays a key role in this process, as it allows for open communication and collaboration in determining the best course of action. The complexities of balancing medical necessity with personal desires highlight the importance of continued research in this area.
Recommendations: Plastic surgeons should focus on providing comprehensive preoperative counseling to patients considering cosmetic procedures to help reduce the risk of decision regret. Additionally, postoperative follow-up and support should be offered to patients to address any complications or concerns that may arise, further minimizing the likelihood of regret. Further studies could also explore the impact of psychological factors, societal pressures, and patient expectations on decision regret in cosmetic procedures.
INTRODUCTION
Decision regret, characterized as “distress or remorse following a healthcare decision,” is common in elective healthcare decisions after surgery. Extensive literature exists on decision regret following breast reconstruction and gender-affirming procedures in plastic surgery. Assessment tools like the five-point Likert scale and the BREAST-Q, and FACE-Q questionnaires, used to evaluate postoperative satisfaction and well-being, do not directly address decision regret. Patients self-report decision regret, often due to unmet expectations. Aesthetic procedures present unique psychological challenges due to the absence of medical necessity. Investigating decision regret is essential to comprehend its impact and enhance patient-provider relationships.
Table 1.
Overview of Research
| Citation | Publication Year | Summary | Key Results | ||||
|---|---|---|---|---|---|---|---|
| Study by Zhong and colleagues in 2013 | Among 10 participants | Findings revealed that patients who were less satisfied with the preoperative information provided by their surgeon experienced higher levels of decision regret, while those with higher self-efficacy reported greater satisfaction. | |||||
| Research by Cai and Momeni (2014) | Year: 2021 | Pages: 63 | The study found a connection between postoperative complications and increased levels of decision regret, while the type of reconstructive surgery did not impact satisfaction levels or decision regret. | ||||
| Reference: | Year: | Sample Size: | Key Findings: |
| Shammas et al 16 | 2022 | 131 | Patients who experienced unsuccessful implant reconstruction exhibited decreased BREAST-Q scores and sexual satisfaction, alongside increased levels of decision remorse. |
BR, breast reduction; IBR, immediate breast reduction; QOL, quality of life.
LITERATURE REVIEW AND DISCUSSION
Preoperative Patient Education
Prior to surgical procedures, educating patients is vital to manage their expectations. Breast reconstruction following mastectomy enhances a patient’s self-perception, which can be reversed by decision regret. Empowering patients before surgery leads to lower levels of decision regret and higher postoperative satisfaction. Shared decision-making is crucial, especially for elective cosmetic procedures.
Research on the impact of preoperative patient education on decision regret postoperatively was conducted by Cai and Momeni 14. They discussed how skills acquired from knowledge can better prepare patients for the consequences of surgical complications. They explored the relationship between breast reconstruction modalities and the degree of decision regret postoperatively. Participants who underwent or had implant-based or autologous breast reconstruction with a minimum of 12-month follow-up were asked to complete the DRS and the BREAST-Q breast satisfaction module. Breast satisfaction or decision regret was not influenced by the reconstructive modality. However, the occurrence of postoperative complications was significantly correlated with higher decision regret scores but did not affect breast satisfaction. These results confirm that preoperative discussions strengthen patient resilience – a quality that plays an important role in conditions of postoperative complications. According to studies conducted by Zhong et al 13 and Cai and Momeni 14, enhanced preoperative education can reduce decision regret among breast reconstruction patients.
The Role of Postoperative Complications
Shammas et al 15 investigated the effect of postoperative complications on decision regret. They assessed the impact of prior unsuccessful implant-based breast reconstruction on long-term patient outcomes following breast reconstruction using free flap transfer. Their analysis included all patients undergoing breast reconstruction with free flap transfer over a 5-year period. Patients with and without a history of implant-based breast reconstruction completed BREAST-Q and DRS questionnaires. After free flap reconstruction, patients with prior unsuccessful implant reconstruction had significantly lower BREAST-Q satisfaction scores and expressed higher decision regret scores. As expected, this study demonstrates that complications increase the risk of decision regret. However, the timing of free flap reconstruction in these cases could be a complicating factor. Thus, in a separate study using BREAST-Q and DRS, Shammas et al 16 demonstrated that decision regret did not affect the timing of free flap reconstruction, including immediate, delayed, or staged.
In contrast to these findings, additional research conducted by Zhong et al 17 found no significant correlation between major postoperative complications and decision regret experience. In their study, Zhong explored the relationship between dispositional optimism, postoperative complications, and decision regret among patients undergoing microsurgical breast reconstruction. A total of 181 women were surveyed, and the results showed that optimism did not have a significant impact on decision regret in White women. However, in non-White women with low levels of optimism, a significant correlation was found between low optimism and decision regret with high levels of mild and severe regret. These results may shed light on possible cultural differences that should be considered during preoperative planning and decision-making processes. Further research is needed to gain a more accurate understanding of these results. Differences in results between Zhong and Shammas studies may be due to their different populations. Shammas used a cohort that had experienced prior implant-based reconstruction failure, while Zhong studied a group that underwent microsurgical breast reconstruction without a history of failed procedures. Additional studies among similar cohorts should be conducted to better understand the impact of postoperative complications on decision regret in breast reconstruction.
The Use of Decision Aids
To improve preoperative information and reduce the risk of decision regret, Luan et al 18 conducted a prospective randomized controlled trial analyzing whether a decision aid could facilitate decision support and structured guidance for surgical breast reconstruction using implants, autologous, and combined methods. The decision aid used was a novel tool providing decision support and structured guidance on implant, autologous, and combined autologous reconstructive surgery. A total of 16 patients were randomized to standard preoperative visits or preoperative visits using the new decision aid. Before the new counseling visit, patients completed a Decisional Conflict Scale (DCS) and the BREAST-Q reconstruction questionnaire. Patients also completed the DRS, postoperative BREAST-Q reconstruction questionnaire, and hospital anxiety and depression scale at 3-5 months postoperatively. While the sample size was small, patients who received the decision aid showed a trend towards decreased decision conflict postoperatively and significantly less decision regret. However, no statistically significant differences in postoperative anxiety/depression were found between the two groups. These results demonstrate that appropriate decision aids can help patients make informed decisions based on their values and preferences and may prevent decision regret, but the study is limited by the small sample size (n=16). Further research is needed to accurately assess the link between preoperative decision aids and postoperative decision regret.
In contrast, Klifto et al 19 found in their prospective randomized controlled trial that decision aids significantly did not reduce substantial discrepancies. Women with newly diagnosed breast cancer seeking reconstruction were prospectively randomized into one of two groups: standard preoperative education versus standard education plus a decision aid. The decision aid was provided in the form of an informational booklet. DCS scores pre and post consultation were obtained. No statistical significance was found between the two groups when comparing overall DCS scores pre-consultation. Since the postoperative DRS was not completed, no conclusions can be drawn about whether these patients experienced decision regret. Additionally, differences in decision aids used by Luan et al and Klifto et al could also lead to different outcomes.
Breast Conservation versus Total Mastectomy
A study by Deliere et al 20 sought to determine whether decision regret affected oncologic resections. They surveyed 1525 volunteers from the Love Research Army who underwent breast cancer surgery between 2009 and 2020. Decision regret scores were compared in the following groups: those undergoing bilateral mastectomy, unilateral mastectomy, breast-conserving surgery, and breast-conserving surgery followed by mastectomy. Bilateral mastectomy was associated with significantly less decision regret than all other oncologic resections.
A recent study by Fortunato et al 21 surveyed patients who underwent mastectomy with or without reconstruction over a 10-year period. Their results on 328 patients showed that emotional and social functioning scores significantly improved in the group that underwent breast reconstruction post-mastectomy compared to the group that did not undergo reconstruction. However, 21% of patients expressed dissatisfaction with their reconstruction or regretted their decision to seek breast reconstruction. Decision regret based on the type of breast reconstruction was not assessed.
CONCLUSIONS AND FUTURE DIRECTIONS
This review has shown that decision regret after breast reconstruction surgery is a complex phenomenon influenced by a variety of factors. Factors such as unmet expectations, patient demographics, oncologic resections, inadequate procedure understanding, and postoperative complications contribute to the experience of decision regret.
Most research on decision regret in plastic surgery revolves around breast reconstruction, and the lack of sufficient studies on this topic should be noted when reading this review. There is even less data on the experience of decision regret in aesthetic procedures such as breast augmentation, abdominoplasty, rhinoplasty, and facelifts. Such cohorts may be vulnerable to decision regret postoperatively due to more psychological rather than medical necessity that leads to.