Background: Surgical management is the mainstay of breast cancer treatment but can cause significant asymmetry. Psychosocial problems associated with asymmetry may negatively impact women’s quality-of-life. Contralateral symmetrisation surgery can be offered to combat asymmetry and improve patient satisfaction. Symmetrisation can be undertaken immediately, alongside the breast cancer surgery, or in a second, delayed procedure. There is no current clinical consensus regarding the optimal timing of symmetrisation. Literature suggests no significant difference in clinical outcomes or surgical complications between the two. However, the impact of timing on patient experience has not been fully explored.
Aims: This explorative study aimed to investigate women’s experiences of breast cancer surgery and associated contralateral symmetrisation.
Methods: Semi-structured interviews were conducted with six participants aged 54-68, between February and March 2024. Data underwent thematic analysis to elicit key themes and core concepts.
Results: Those that underwent delayed symmetrisation described significant asymmetry between operations, uncertainty about future symmetrisation timing and feelings of anxiety and abandonment. They noted that their cancer journey felt incomplete until their second surgery had occurred, extending psychological burden and profoundly impacting psychological wellbeing. Study participants prioritised avoidance of this period of asymmetry over potential subtle improvement in long-term aesthetic outcomes. Lasting asymmetry was better tolerated in women that had undergone immediate symmetrisation, where it was seen to be secondary to cancer treatment. Asymmetry following delayed procedures was seen as failure of the symmetrisation process.
Conclusions: This study provides direction for improvement of pre-operative counselling. Although timing of symmetrisation is patient-specific, immediate symmetrisation should be considered where feasible to avoid distress associated with delayed procedures. Themes identified were used to design a questionnaire sub-study involving additional participants self-assessing their experiences; 14 have been recruited with data collection ongoing. Findings from the sequential exploratory mixed methods study will be applied to future prospective research.