When to decide about breast reconstruction

My name is Rebecca Van Loy. I'm a clinical psychologist and I support people affected by cancer.

So a psychologist that supports people affected by cancer, assisting them with their emotional, physical, psychological adjustment. So the role of a psychologist is really helping someone identify the gaps in the knowledge that they may have about both the procedure and the recovery process and help them identify the questions that they may have from their supports, their team and make sure that they have the information that they need to have confidence in the decision that they've arrived at.

Throughout my practise, I've probably identified six key factors that drive people's decision making around whether to have breast reconstruction or flat closure. 
The six factors are:

1.    Context. So the context in which a person is trying to make the decision, is it on the back of chemotherapy or treatment complications that they've experienced and just understanding the way that might be influencing their decision.
2. The 2nd is how their decision influences others. So sometimes we might be unduly placing weight on how the decision affects our family, our workplace, our caring responsibilities, those sorts of things.
3. The third factor relates to individual preferences. So thinking about the desire for symmetry, the desire for being able to maintain physicality if someone enjoys tennis or Pilates or those sorts of things, or preference to keeping up their clothing or their design or their appearance.
4. The 4th factor is information. Is the information source that you're using a broad sense of information or is it quite narrow? Have you considered the views? You know both of the questions for your surgeon, your breast care nurse, looking at BCNA and other types of resources, or are you relying on quite a narrow information source just in terms of things that you might have seen or read?
5. The 5th factor relates to fear, and sometimes fear may be unduly deciding or driving someone's decision. That could be fear of complications, fear of a long surgery, fear of having something foreign in your body and how you might feel about it. So just understanding where fear might be having a role.
6. And the sixth factor relates to resources and sometimes people's decisions about resources that they have access to or concerns about the cost of surgery or how that might be having an impact can negatively impact a person's decision making.

Decision regret is really where a person may be second guessing or having concerns that they may not have, you know, gone through the right procedure. It's often very complex. It is generally more commonly experienced where someone may have had complications, so they may have required unexpected surgeries or where recovery may have taken longer than expected. Decision regret can be quite debilitating for people and lead to feelings of anxiety. It can really interfere with people's moods. So, if someone is really struggling with their decision, it's really important to ask for help and to reach out through those networks like BCNA, like the Cancer Council or finding a psychologist to talk through those concerns.

So, it's important for people to give themselves time to adjust to their new body after surgery because there's so many, it's a moving state, it's a changing state. You know, often immediately after surgery, there's swelling, there's scarring, The body doesn't immediately look like how it might look in three years’ time or five years’ time. And a common line that people often say is, you know, I, I wasn't expecting perfect, but I just expected something different. And so, it's really important that people feel reassured that talking about these concerns doesn't mean that they're looking for perfection at the end of surgery, but they're just trying to make sense of what their body and what these changes might look like and mean to them or their partner or those people that are significant to them.

What I'd like people to take away is that decision making is complex, and everyone needs support in getting through that decision. Adjustment is not the same as decisional regret and it's never too late to reach out and ask for support. It doesn't matter if it's a couple of years after your surgery, it's just important to access the key supports that you need.