{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:15:09Z","timestamp":1792152909728,"version":"4.4.0"},"reference-count":59,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"Importance<\/jats:title>Up to 40% of women experience dissatisfaction after breast reconstruction due to unexpected outcomes that are poorly aligned with personal preferences. Identifying what attributes patients value when considering surgery could improve shared decision-making. Adaptive choice\u2013based conjoint (ACBC) analysis can elicit individual-level treatment preferences.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To identify which attributes of breast reconstruction are most important to women considering surgery and to describe how these attributes differ by those who prefer flap vs implant reconstruction.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This web-based, cross-sectional study was conducted from March 1, 2022, to January 31, 2023, at Duke University and between June 1 and December 31, 2022, through the Love Research Army with ACBC analysis. Participants were 105 women at Duke University with a new diagnosis of or genetic predisposition to breast cancer who were considering mastectomy with reconstruction and 301 women with a history of breast cancer or a genetic predisposition as identified through the Love Research Army registry.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Relative importance scores, part-worth utility values, and maximum acceptable risks were estimated.<\/jats:p><\/jats:sec>Results<\/jats:title>Overall, 406 women (105 from Duke University [mean (SD) age, 46.3 (10.5) years] and 301 from the Love Research Army registry [mean (SD) age, 59.2 (11.9) years]) participated. The attribute considered most important was the risk of abdominal morbidity (mean [SD] relative importance [RI], 28% [11%]), followed by chance of major complications (RI, 25% [10%]), number of additional operations (RI, 23% [12%]), appearance of the breasts (RI, 13% [12%]), and recovery time (RI, 11% [7%]). Most participants (344 [85%]) preferred implant-based reconstruction; these participants cared most about abdominal morbidity (mean [SD] RI, 30% [11%]), followed by the risk of complications (mean [SD], RI, 26% [11%]) and additional operations (mean [SD] RI, 21% [12%]). In contrast, participants who preferred flap reconstruction cared most about additional operations (mean [SD] RI, 31% [15%]), appearance of the breasts (mean [SD] RI, 27% [16%]), and risk of complications (mean [SD] RI, 18% [6%]). Factors independently associated with choosing flap reconstruction included being married (odds ratio [OR], 2.30 [95% CI, 1.04-5.08]; P<\/jats:italic>\u2009=\u2009.04) and higher educational level (college education; OR, 2.43 [95% CI, 1.01-5.86]; P<\/jats:italic>\u2009=\u2009.048), while having an income level of greater than $75\u202f000 was associated with a decreased likelihood of choosing the flap profile (OR, 0.45 [95% CI, 0.21-0.97]; P<\/jats:italic>\u2009=\u2009.01). Respondents who preferred flap appearance were willing to accept a mean (SD) increase of 14.9% (2.2%) chance of abdominal morbidity (n\u2009=\u2009113) or 6.4% (4.8%) chance of complications (n\u2009=\u2009115).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study provides information on how women value different aspects of their care when making decisions for breast reconstruction. Future studies should assess how decision aids that elicit individual-level preferences can help tailor patient-physician discussions to focus preoperative counseling on factors that matter most to each patient and ultimately improve patient-centered care.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2023.4432","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T15:34:04Z","timestamp":1695828844000},"page":"1285","source":"Crossref","is-referenced-by-count":27,"title":["Patient Preferences for Postmastectomy Breast Reconstruction"],"prefix":"10.1001","volume":"158","author":[{"given":"Ronnie L.","family":"Shammas","sequence":"first","affiliation":[{"name":"Division of Plastic, Maxillofacial and Oral Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Hung","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice 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