What makes a 'good' mastectomy? - A national qualitative study of health care professionals opinions on mastectomy without reconstruction.

[PURPOSE] - Seventy percent of women who undergo mastectomy for breast cancer in the UK have no reconstruction (MxNR). There are limited data on cosmetic and functional outcomes after MxNR. There is increasing interest in 'aesthetic flat closure', recognising that many women have a poor-quality MxNR with dents, skin folds and bulges, causing distress, and difficulties wearing a bra or prosthesis. Aims - To explore health-care-professionals (HCP) views around MxNR.

[METHODS] Semi-structured qualitative interviews with UK HCP, (breast surgeons, prosthetists and breast care nurses). Data analysis used the Framework approach.

[RESULTS] Twenty-six interviews were performed (19 surgeons, 2 prosthetists, 5 breast care nurses) in 2023. Three major themes were identified: technical aspects of MxNR, preoperative counselling, and patient experience. Clinicians believed a good MxNR is a well healed, flat, even chest-wall which fits a prothesis. Prosthetists felt poor scar characteristics were common. Poor scar causation was deemed multifactorial (seroma, infection, obesity and radiotherapy). Low scar placement was considered optimal, either near, or at, the inframammary fold (IMF). Lateral excess skin was the most common post-operative problem. A range of techniques to optimise outcomes were described. Preoperative counselling was considered suboptimal. Most HCP felt age, relationship status and being sexually active were factors which affect patient experience.

[CONCLUSION] Enhanced training in a range of techniques may help to improve MxNR scar quality. The MxNR patient pathway requires reform, including better counselling with example photographs, to facilitate shared decision making and manage patient expectations.