Women's Experienced Well-Being and Satisfaction after Breast Reconstruction: A Mixed-Method Study

Women's Experienced Well-Being and Satisfaction after Breast Reconstruction: A Mixed-Method Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Women's Experienced Well-Being and Satisfaction after Breast Reconstruction: A Mixed-Method Study Matilda Karlsson, Chamiran Saume, Jenny Drott This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8592946/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Breast cancer is the most common malignancy among women in Sweden. Breast reconstruction, recommended after breast-conserving surgery or mastectomy, is chosen by over 30% of patients and aims to improve quality of life beyond restoring appearance. Despite its recognized role in cancer care, evidence on women’s experiences and satisfaction remains limited. This study addresses this gap by exploring perceived well-being and satisfaction following reconstruction. Methods A convergent parallel mixed-methods design was applied. The study was conducted at a university hospital plastic surgery clinic between October 2024 and February 2025. All women (≥ 18 years) who underwent breast reconstruction in 2023 were invited, and 43% of them were included. Quantitative data were collected using the questionnaire Breast-Q and qualitative data were obtained through semi-structured interviews. Results Twenty-six women completed the questionnaire, and twenty participated in interviews. Psychosocial and sexual well-being, as well as breast satisfaction, were generally comparable to normative levels, suggesting a potential “normalizing” effect of reconstruction. Participants frequently described feeling socially secure, feminine, and attractive. However, many reported sexual insecurity, disappointment, and fatigue following surgery. Although overall breast satisfaction was high, asymmetry emerged as a source of dissatisfaction. Physical well-being scored below normative values, often due to functional limitations. Despite predominantly positive outcomes, a pronounced need for improved information and guidance remained. Conclusions Breast reconstruction appears to support psychosocial recovery and body image normalization, yet challenges related to physical limitations and sexual well-being persist. These findings underscore the importance of evidence-based nursing and comprehensive pre- and postoperative counselling. Enhanced patient education and individualized support may improve satisfaction and overall quality of life. Breast Reconstruction Evidence-Based Nursing Mixed-methods Patient Satisfaction Postoperative care Quality of life Figures Figure 1 BACKGROUND Breast cancer is the most prevalent malignancy among women globally and in Sweden, with approximately 10,000 Swedish women diagnosed annually (1). Following breast-conserving surgery or mastectomy—whether due to cancer or hereditary predisposition—breast reconstruction is recommended as part of comprehensive cancer care. More than 30% of women choose to undergo reconstruction (2). Reconstruction is considered an integral component of breast cancer treatment, aiming not only to restore physical appearance but also to enhance health-related quality of life by improving body image, self-esteem, sexuality, and psychological well-being. A personalized treatment plan should be developed collaboratively by the plastic surgeon, breast surgeon, and the woman, ensuring alignment with preferences and expectations. However, reconstruction practices vary internationally (3, 4). Throughout this process, women must be well-informed, actively involved in decision-making, and supported by a multidisciplinary team, including nursing professionals and healthcare leadership(5). This approach addresses physical, psychological, and emotional needs, reflecting the principles of person-centred and evidence-based nursing care. Selection of reconstruction technique depends on factors such as residual breast tissue, comorbidities (e.g., cardiovascular disease, obesity), prior or planned radiation therapy, and individual preferences. The two primary techniques are implant-based reconstruction and autologous tissue reconstruction. Autologous methods involve pedicled or free flaps, commonly harvested from the abdomen, back, gluteal, or thoracic regions (3, 6). At the current clinic, three main methods are used: Immediate implant-based reconstruction (performed concurrently with mastectomy); Delayed reconstruction using a free abdominal flap (DIEP) and Delayed reconstruction using a pedicled Latissimus Dorsi (LD) flap. Each method carries specific benefits and risks. Implant-based reconstruction, while less complex, is associated with complications such as infection, implant displacement, and capsular contracture, particularly in irradiated tissue. DIEP flap reconstruction is more extensive, requiring hospitalization and close monitoring, and is contraindicated in women with obesity, smoking habits, or vascular disease. LD flap reconstruction involves shorter hospitalization and lower circulatory risk but may cause functional limitations in the shoulder region (7, 8). Delayed reconstruction is often preferred when radiation therapy is planned, as autologous tissue reduces complication rates compared to implants (9). Common postoperative complications include pain, nausea, hematoma, fat necrosis, infection, seroma, and wound dehiscence (7, 8). Women’s experiences and outcomes vary depending on surgical technique, postoperative care, and expectations. Evidence from a recent Cochrane review suggests that autologous reconstruction may offer greater psychosocial and sexual benefits (10), although consensus on the optimal method remains lacking (4). Understanding women’s experiences and perceptions is essential, as these factors significantly influence satisfaction and long-term quality of life (4, 11). Systematic analysis of these experiences enables healthcare providers, particularly nurses, to identify critical determinants of care outcomes and implement evidence-based nursing interventions that promote person-centred care in accordance with McCormack and McCance’s framework for person-centred care (11–13). Nurses play a pivotal role in preoperative counselling, postoperative monitoring, and ongoing psychosocial support. Evidence-based nursing interventions, such as structured information delivery, shared decision-making, and continuity of care, are essential to optimize patient outcomes and reduce unmet informational and emotional needs. This study aims to explore women's perceived well-being and satisfaction following breast reconstruction. This study seeks to address the following research questions: How do women perceive and evaluate their psychosocial, sexual, and physical well-being following breast reconstruction? What is the level of satisfaction among women regarding the outcomes of breast reconstruction and the adequacy of preoperative information provided? METHOD Design A convergent parallel mixed-methods design ( Creswell (14)) was used to address the research questions. Quantitative data were derived through the patient reported outcome instrument Breast-Q (15), and comparison with Swedish normative scores on well-being and breast satisfaction amongst women who has not undergone breast surgery (16). Qualitative data was collected through semi- structured individual interviews. This study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) framework (17). Setting and Study population The study was conducted in a plastic surgery clinic at a university hospital in Sweden, which is an accredited Comprehensive Cancer Centre. All women (n=60), 18 years or older who underwent breast reconstruction at the clinic during 2023, were invited to participate in the study. Invitations were sent by mail, including instructions to complete a questionnaire and participate in a telephone interview. Those who consented returned the completed questionnaire together with the signed consent form. Women who agreed to be interviewed were contacted by phone. Data collections took place between October 2024 and February 2025. Data collection The concurrent data collection of quantitative and qualitative data, as described by Creswell’s convergent parallel mixed-methods design, was chosen to comprehensively address the study aim and research questions. Quantitative data provide measurable outcomes regarding psychosocial, sexual, and physical well-being as well as satisfaction levels, while qualitative interviews capture women’s subjective experiences and contextualize these findings. Integrating data enables a deeper understanding of not only how women rate their well-being and satisfaction, but also why they perceive these outcomes as they do, thereby generating evidence that supports person-centred and evidence-based nursing practice. Quantitative data The Breast-Q reconstruction module (version 2.0) (15) in an approved Swedish translation was obtained (18). The instrument is designed to evaluate outcomes after breast reconstructive surgery and is composed of several pre- and postoperative scales. Results from the following postoperative scales will be reported: psychosocial, sexual, and physical well-being related to the breast area, and satisfaction with the breast and information. Each scale contains questions answered on a Likert scale 1-4 were the higher the score the better (19). Summarized scores were converted into a rash total score from 0 (worst) to 100 (best) using conversion tables provided, quantifying the data (18). Data collection stopped after 26 questionnaires were returned to the clinic. In addition to Breast-Q data, published Swedish normative values on well-being and satisfaction with breasts were used (16). Qualitative data Semi-structured telephone interviews were conducted. The interviewers were female nurses (first and second author) with long clinical experience in caring for these patients and also experience in research. The pilot-tested interview guide included two main questions: “ Can you describe your experiences and perspectives on your health in relation to the breast reconstruction you have undergone?” and “What is your perception of the care and healthcare quality associated with the surgery?” . The interview guide focused on eliciting narratives concerning perceived opportunities and barriers associated with the reconstruction process, as well as different dimensions of health, including physical, psychological, social, emotional, and overall satisfaction. To deepen and clarify the participants’ responses, probing techniques was used throughout the interviews, with prompts such as “Can you tell more?”, “How…?”and “In what way…?”. The interviews were held by one of the nurses in a quite office at the clinic and lasted between 11-42 minutes (average 21 minutes). All interviews were audio-recorded and transcribed verbatim. Eleven interviews were conducted for the qualitative part of the study. Data collection was deemed sufficient to achieve informational power, ensuring the ability to meaningfully address the research question (20). Clinical characteristics were included as; age, Body Mass Index (BMI), and documented postoperative complications were extracted for women who consented to participate. Postoperative complications included both severe complications such as postoperative bleeding and milder complications such as delayed wound healing. Further classification and description of complications are beyond the scope of this study. Data Analysis The data extracted from the Breast Q, normative data and interview transcripts were initially analyzed separately and later compared and integrated in line with the method (14). Quantitative analysis Data were analyzed using SPSS® version 30 (IBM Corporation). Categorical data were presented as frequencies (n) and percentages (%). Group differences were assessed using the Chi-square test or Fisher’s Exact Test. Continuous variables were reported as means with 95% confidence intervals (CI), following confirmation of normal distribution using the Shapiro-Wilk test. Independent samples t-tests were used for two group comparisons whilst multiple groups were analyzed using one-way ANOVA. The assumption of homogeneity of variances was verified using Levene’s test, and post hoc comparisons were performed using the Bonferroni. To facilitate comparison with previously published BREAST-Q studies, data were also analyzed using the non-parametric Kruskal-Wallis test (KWA). These results (Supplementary Table 1) were consistent with those obtained from parametric analyses. For comparisons with Swedish normative data, independent samples t-tests were conducted using published means and standard deviations, with calculations performed in the online statistical tool OpenEpi (21). A p-value < 0.05 was considered statistically significant for all analyses. Qualitative analysis The interviews were analyzed inductively using qualitative content analysis (14, 22).The initial steps were carried out by the first and second authors, which read the transcripts repeatedly to gain an overall understanding of the content. The initial steps of systematically coding the data to identify initial codes were carried out independently by both authors. The findings were then discussed within the research team to strengthen trustworthiness. The themes were subsequently organized under the overarching themes represented by each Breast-Q scale, which can be seen as a deductive step in the otherwise inductive approach. According to Creswell this can be done when using established questionnaires (14). Themes without a direct link to a Breast-Q scale were assigned to the most appropriate overarching theme based on the authors’ interpretation. According to Creswell, these themes represent the most important insights and are presented and discussed as silent results (14). Triangulation and Integration Responses from each scale were used for triangulation. For psychosocial and sexual well-being, response categories were collapsed as follows: 1 = never and 2 = a few times combined into “never”; 3 = quite often remained unchanged; and 4 = almost always and 5 = all the time combined into “always.” This aligns with the response format of the module “physical well-being of the breast area” and facilitates triangulation reporting. Satisfaction was dichotomized such that “very dissatisfied” and “somewhat dissatisfied” responses were categorized as “dissatisfied,” and “somewhat satisfied” and “very satisfied” as “satisfied,” simplifying the integrated results. A triangulation protocol (23) was used to identify content areas in both analyses. This was followed by consideration of convergence, divergence, complementary, and silent results, being those that appear only in one data set (questionnaire or interview). Silent results can enhance understanding or lead to further research. Identifying divergence between methods is a vital part of this process, as exploring such differences may deepen the understanding (14, 24). The merged quantitative and qualitative findings are presented in continuous text. Integration is organized by the Breast Q scales (overarching themes), results from statistical analyses followed by the identified themes and response rates (14). To illustrate identified themes, relevant quotes are included. The integrated narrative is followed by a joint display (figure 1) where overarching themes are reported alongside quantitative data and qualitative data (interview quotes). Priority (14) was given to the qualitative phase in this study as it focused on in-depth explanations of the quantitative results obtained from Breast-Q. Ethics The study received approval from the Swedish Ethical Review Authority (reference number 2024–05864-01) and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants provided written informed consent prior to data collection. The consent process emphasized the voluntary nature of participation and informed participants that they could withdraw at any time without any consequences. RESULTS Twenty-six women of the total patient population in 2023 (n=60, response rate 43%) responded to the questionnaire and twenty consented to an interview. To achieve a purposive sample representing variation in both age and type of reconstruction, eleven women were included in the interview study (Table 1). This strategic sampling aimed to ensure a breadth of experiences and perspectives within the current patient group and in line with the mixed method approach and the research questions. Table 1. Study participant characteristics Questionnarie (n=26) Interview (n=11) Age (years) 55 (50-59) 54 (45-62) BM BMI 25 (24-26) 26 (24-28) Indication for surgery Profylactic (BRCA) 5 (19 %) 2 (18 %) Therapeutic (breast cancer) 21 (81 %) 9 (82 %) Radiation 17 (65 %) 7 (64 %) Surgery DIEP-flap 10 (39 %) 4 (36 %) LD – flap 11 (42 %) 4 (36 %) Direct reconstruction with implants 5 (19 %) 3 (28 %) Postoperative complications* 12 (46 %) 3 (28 %) Numbers are mean (95 % CI ) or frequency (percentage). * capsular contracture (n=1), implantat displacement (n=1), delayed wound healing (n=4), postoperative bleeding (n=3), SSI (n=2), seroma (n=1) The findings are presented in order of research questions and the five domains derived from the BREAST-Q scales and qualitative analysis: (1) psychosocial well-being, (2) sexual well-being, (3) physical well-being in the breast area, (4) satisfaction with breasts, and (5) satisfaction with information. Within each domain, quantitative and qualitative insights, highlighting areas of convergence between data sources. How do women perceive and evaluate their psychosocial, sexual, and physical well-being following breast reconstruction? Impact on Psychosocial Well-Being The mean Breast-Q score for psychosocial well-being was 66 (59-72) (Table 2), similar to the Swedish normative score (p=0.801) (Table 3). Women with an LD flap reported significantly lower psychosocial well-being compared to those with a DIEP (p=0.018). No other significant differences were observed (Table 2). The participants described in various ways how the breast reconstruction process had affected them psychologically and socially, with both positive and negative aspects. Six themes emerged: self-image, social confidence, social support, expectations, future perspectives and displeasure (due to a long waiting process). Self-Image In self-image and social confidence (convergence), survey data showed 58% accepted their bodies, 50% felt normal, and 69% always felt socially confident. Interviews confirmed these findings, with women describing feeling “whole” and “victorious” over cancer, while others struggled with disfigurement and altered body image. “…you feel more like a whole person and it’s kind of like giving the disease the finger, like saying no, I have overcome this.” (A 62-year-old woman who had undergone DIEP reconstruction) Table 2. Demographic data and total Breast-Q scores with respect to reconstruction type All (n=26) DIEP (n=10) LD (n=11) Implants (n=5) p values Bonferroni adjusted p values Age (years) 55 (50-59) 54 (48-60) 59 (51-68) 45 (39-52) 0.058 BMI 25 (24-26) 25 (23-27) 24 (22-25) 28 (25-31) 0.017* 0.015 (implants-LD) Well being Psychosocial 66 (59-72) 75 (62-87) 56 (49-63) 69 (54-84) 0.018* 0.018 (DIEP-LD) Sexual 44 (38-51) 48 (34-61) 41 (31-51) 45 (32-59) 0.598 Physical 85 (78-92) 84 (69-99) 83 (73-93) 91 (80-102) 0.633 Satisfaction Breast 58 (52-65) 56 (41-71) 60 (49-71) 60 (38-82) 0.872 Information 56 (49-63) 56 (44-68) 59 (49-68) 52 (21-82) 0.760 Numbers are means (95 % CI). * significant values Table 3. Comparison between study participants and published Swedish normative values Breast reconstructed women (n=26) Women not breast operated (n=146) p values mean (SD) mean (SD) Psychosocial well-being 66 (16) 66 (19) 0.801 Sexual well-being 44(16) 50 (20) 0.15 Physical well-being (chest) 85 (16) 98 (5) <0.001 Physical well-being (back and shoulders) * 57 (22) 79 (18) <0.001 Satisfaction breast 58 (17) 57(13) 0.731 * LD module Social Confidence Overall, 69% (18) reported always feeling confident in social settings and capable of doing what they wished. They felt feminine and emotionally stable. The majority (85%) reported always feeling as valuable as other women, which was also confirmed (convergence) in the interviews, where several women highlighted the positive experience of being able to wear regular clothes, feel comfortable at the public swimming pool, and not feel the need to wear prostethic breast in social contexts. Some participants expressed that the reconstruction had not affected their social life at all. “…the only difference is that I couldn’t undress in the locker room… it’s different after the surgery.” (A 50-year-old woman who had undergone DIEP reconstruction) Social Support Social support (silence) was not addressed in the questionnaire, but interviews emphasized support from partners, peers, and healthcare professionals. Several sought peer groups online for reassurance. “…these groups have been very supportive. I am grateful they exist and that you can have a dialogue with others who are in similar situations.” (A 44-year-old woman who had undergone LD reconstruction) Expectations and future perspectives Related to expectations and future perspectives (silence), interviews revealed unmet expectations regarding aesthetic outcomes and a desire to move forward, contrasted by anxiety in prolonged processes. “It turned out smaller than I had expected, but no—I don’t have the energy to go through it again.” (A 41-year-old woman who had undergone DIEP reconstruction) The Breast-Q questionnaire did not include questions regarding the women’s outlook on the future (silence), but the interviews revealed that several participants had thoughts about it. Some expressed hope and a desire to bring closure to what they experienced as a prolonged process. “You don’t really stop to think and dwell on it either. You want to move forward and move on all the time. Yes, life goes on.” (A 50-year-old woman who had undergone DIEP reconstruction) Others whose process had been prolonged and complicated expressed anxiety about never feeling finished or able to accept their new body. “…but there is also anxiety. Will it be okay? Will it ever be okay?” (A 42-year-old woman who had undergone implant-based reconstruction) Displeasure after a long waiting process In 8 of the 11 interviews, frustration was expressed over long waiting times and uncertainty about when their surgery would be performed, even though they understood that external factors such as COVID-19 could have an impact. Some described having to contact healthcare several times to get information. "I had to wait a very long time... I think I called four or five times because I felt it was taking an awfully long time ." (A 69-year-old woman who had undergone LD reconstruction) Breast-Q does not include any questions about the overall experience of the duration of the process (silence). 2.Impact on Sexual Well-Being The mean score was 44 (38–51), with no differences between reconstruction types or norms (p = 0.15). Half of the women reported dissatisfaction with their sex life, and 58% lacked confidence about their breast area when naked (Table 2). Interviews rarely addressed intimacy, suggesting silence despite survey signals of need. A total of 73% (19) indicated that they never felt sexually attractive when naked. Despite this, only one informant addressed the sexual aspect, reflecting on whether a partner might have influenced her experience of the reconstruction, which is interpreted as a silence on the subject. “…if I had had a partner, I probably would have had completely different thoughts, but now I don’t have a partner I need to show myself to.” (A 81-year-old woman who had undergone LD reconstruction) 3. Impact on Physical Well-Being in the Breast Area Scores were significantly lower than norms (mean 85; p < 0.001), with no differences between reconstruction types (Table 2 and 3). Most women reported no persistent pain, yet tightness and movement limitations were common: 50% felt pulling, 39% reported chest muscle pain, and 35% experienced tightness. LD-specific back/shoulder scores were markedly lower than norms (mean 57 [41–71], p < 0.001). Interviews confirmed these findings and highlighted complications (e.g., seroma, infection) that prolonged recovery. “I have recovered completely, I think, and I can move however I want… so it feels like my health is in good condition.” (A 41-year-old woman who had undergone DIEP reconstruction) Movement Limitations Half (13) reported feeling some pulling in the breast area, 39% experienced pain in the chest muscles either fairly often (9) or always (1), and 35% (9) reported fairly frequent (8) or constant (1) tightness in the breast area. These experiences were also raised by participants in the interviews (confirmatory), particularly among those who had undergone LD reconstruction. In the LD-specific physical well-being scale addressing the back and shoulder, women scored significantly lower (mean 57, 41-71) than normative values (p < 0.001) (table 3). “…I feel it stretching and pressing… it tightens every time I move.” (A 69-year-old woman who had undergone LD reconstruction) Complications Complications impacts are not addressed in the Breast-Q (silence). The informants described recovery as long and challenging, with complications such as seroma and infection leading to frequent hospital visits and prolonged recovery. “…it was more troublesome than I had expected. Recovery took longer than I anticipated.” (A 60-year-old woman who had undergone LD reconstruction) What is the level of satisfaction among women regarding the outcomes of breast reconstruction and the adequacy of preoperative information provided? 4. Satisfaction with Breasts The mean score was 58 (52–65), similar to norms (p = 0.731). Over 80% were satisfied with breast shape when clothed, but only half were satisfied when undressed (Table 3). Interviews diverged from survey data, with most expressing dissatisfaction related to asymmetry, size differences, and unnatural appearance or sensation. Some declined corrective surgery due to treatment fatigue, while others hesitated to voice dissatisfaction. “I’m disfigured, you could say. It doesn’t feel much different from when I only had one breast.” (A 41-year-old woman who had undergone DIEP reconstruction) Two themes were identified: asymmetry and size, and natural appearance and sensation, both reflected in the questionnaire. Asymmetry and Size Fifteen (58%) reported satisfaction with how symmetrical or equal their breasts were, and 17 (65%) reported satisfaction with size. In the interviews, several described asymmetry and size differences as a significant concern, which is interpreted as a contradictory (divergence) finding. Only one woman described her breasts as symmetrical, having undergone corrective surgery. Another reported still using inserts after surgery to balance the difference. “I had expected the breasts to be more or less the same size—at least to look that way when wearing clothes.” (A 41-year-old woman who had undergone DIEP reconstruction) Some shared their experiences with the surgeon, who saw no noticeable difference. Other women declined corrective surgery due to lack of energy. Some did not dare to openly express their feelings, having been informed about possible asymmetry. “…I said I knew I was warned there would be a difference between the breasts, but I thought it was a bit too big a difference. Then he looked and said he didn’t think so, but that it looked very good. But I don’t think so. Maybe I was too timid and should have said I was not satisfied, but I didn’t.” (A 69-year-old woman who had undergone LD reconstruction) Natural Appearance and Sensation Fourteen women (54%) reported satisfaction with how natural their reconstructed breast looked and felt to the touch. However, in the interviews, two woman described the breast as unnatural and hard and a third expressed significant loss of sensation. The interview findings are interpreted as contradictory, as no positive experiences were reported. “There is a very big difference between the old skin that remains and the transplanted skin. If you look at it, it really is like a glued-on skin patch. But that’s only me who sees it.” (A 53-year-old woman who had undergone DIEP reconstruction) 5. Satisfaction with Information The mean score was 56 (49–64), with no differences between reconstruction types (Table 2). Surveys indicated high satisfaction with surgical information (92%), options (85%), and complications/recovery (73%). In contrast, interviews revealed insufficient counselling (divergence): consultations were perceived as brief and rushed, lacking details on postoperative appearance, drains, risks, and recovery timelines. “…I had like a thousand questions and concerns, and they couldn’t answer them. I didn’t feel safe. I really went onto the operating table wondering what it would be like when I woke up, or what I would look like.” (A 42-year-old woman who had undergone implant-based reconstruction) More than half (53%) wanted clearer expectations for regaining normality and insight into other women’s experiences. Several sought information via social media. One positive outlier attended a clinic information evening with peer demonstrations, which strongly influenced her decision-making. “I can say that if I had known what I know today, I’m not sure I would have done it… I probably would have thought twice if I had known that such complications could occur.” (A 69-year-old woman who had undergone LD reconstruction) “…I asked if there were any pictures or anything of patients who had undergone the surgery, or how I could expect it to look… I think it’s interesting to hear about others’ experiences, whether they differ from my own.” (A 44-year-old woman who had undergone implant-based reconstruction) A contradictory finding to these experiences was seen in one women’s interview, who described an information evening at the relevant clinic she had attended as follows: “…they were going to have an information evening where doctors talked about different reconstruction options. There were quite a few people there. They showed how it looks, people lifted their shirts and showed, including those who chose not to have reconstruction. You could say it was there and then that I decided I wanted reconstruction.” (A 62-year-old woman who had undergone DIEP reconstruction) Summary of Integration Divergence between surveys and interviews was most pronounced in domains of information and breast satisfaction, underscoring the complexity of patient experiences. Quantitative data suggested overall satisfaction and well-being comparable to norms, while qualitative findings exposed gaps in information, unmet expectations, and psychosocial challenges. The findings underscore a need for structured, patient-centred information strategies that go beyond procedural details to include psychosocial aspects and peer experiences. FIGURE 1 is uploaded separately in order to avoid section breaks (affecting line numbers) and to be in the correct orientation (horizontal) DISCUSSION This mixed-methods study provides a comprehensive understanding of women’s experiences and satisfaction following breast reconstruction, addressing both psychosocial and physical dimensions. The findings illustrate a nuanced interplay of convergent, divergent, and silent results. Importantly, previously unarticulated or silent insights- primarily emerging from the qualitative interviews and offer a deeper understanding of the women lived experiences. These insights underscore the need for evidence-based nursing interventions that prioritize individualized support. Nursing professionals hold a pivotal role in translating these findings into practice by ensuring empathetic communication, promoting continuity of care, and integrating psychosocial support throughout the reconstructive process. Although the BREAST-Q scores indicated that psychosocial well-being in the reconstructed group was comparable to normative values, the qualitative data uncovered emotional and relational complexities. Some women reported feeling exhausted after a long unexpected reconstructive process, and worried that the process would never end, while others saw a bright future. These insights underscore the importance of discussing and measuring expectations within this group. Women who underwent LD reconstruction, who had the lowest BMI, reported significant lower psychosocial well-being scores (mean difference − 19 from DIEP). These findings partly contrast with previous studies, which have shown higher psychosocial well-being in women with LD and lower BMI (25, 26). This discrepancy may be due to the small sample size and timing of assessment. An important silent theme emerging from the interviews was the need for emotional support and information sharing beyond clinical facts. Women with breast cancer frequently seek information and support through digital media (27). Several participants expressed a strong desire to connect with other women who had undergone reconstruction, emphasizing that peer narratives could help set realistic expectations and ease feelings of isolation. This phenomenon is confirmed and described in an interview study, where social support is proposed as future theme in Breast-Q (28). Sexual well-being emerged as a consistently low-scoring domain, aligning with previous research (10, 25). While this may partly be explained by psychological distress, pain, and discomfort following breast cancer surgery (15), Jepsen’s study on normative scores suggests a broader complexity: “healthy” women in Sweden, the United States, Australia, and the Netherlands also report low sexual well-being (16). This indicates that sexual health concerns may not be solely attributable to breast cancer or reconstruction but could reflect cultural, relational, or systemic factors influencing women’s sexual experiences. Interestingly, despite low scores in the present study, only one participant spontaneously addressed the potential impact of the reconstructed breast on her sexuality. This silence may point to the sensitive nature of the topic or, more likely, to limitations in the interview guide, which lacked a direct question on sexual well-being. Future research should therefore incorporate explicit prompts to capture these nuanced experiences and inform evidence-based nursing interventions aimed at holistic recovery, including sexual health support. Previous research suggests that preoperative emotional well-being predicts postoperative sexual outcomes; women reporting happiness prior to reconstruction demonstrated significantly higher sexual well-being one year later compared to those who felt unhappy. Implant-based reconstruction has been associated with better sexual well-being than autologous techniques (29), although this finding was not replicated in the present study and lacks support from recent Cochrane evidence (10). Notably, some women experience improved sexual health following reconstruction (29), potentially linked to perceptions of the breast as integral to femininity and attractiveness. Furthermore, a Swedish study indicates that women undergoing reconstruction report superior sexual function compared to those who forgo reconstruction (30), underscoring the importance of addressing sexuality and expectations in preoperative consultations. Preoperative factors such as overweight and mental health issues have been linked to poorer psychosocial and sexual well-being after reconstruction (31), highlighting the need for structured assessments and individualized preoperative evaluations. Physical well-being in the breast area was rated relatively high but remained below normative values and lower than figures reported for reconstructed Finnish women (25). Global comparisons further reveal substantial variation in physical well-being among non-operated women (32). No significant differences across reconstruction types were observed in this study, consistent with findings from a Finnish cohort (25). However, women undergoing LD reconstruction more frequently reported discomfort related to tightness and mobility, as well as reduced well-being in the back and shoulder region (Table 3 ), as captured by the LD-specific module, findings corroborated by interviews and previous Swedish research (33). These results underscore the importance of procedure-specific instruments to identify concerns unique to different reconstruction techniques (34). Satisfaction with the breasts among participants was comparable to that of non-operated Swedish women, suggesting that reconstruction may serve a “normalizing” function. While previous research reports higher satisfaction with autologous reconstruction compared to implants (25), this difference was not observed in the present study. Interviews revealed greater satisfaction with breast appearance when clothed than naked yet also uncovered complex and sometimes contradictory emotions. Despite relatively high Breast-Q scores, several women expressed dissatisfaction with aesthetic outcomes, particularly asymmetry, reduced size, and sensory loss. These findings highlight that questionnaires may not fully capture subjective experiences, and that satisfaction is a multifactorial construct. By integrating qualitative interviews with quantitative measures, the study demonstrates that satisfaction is a multifactorial construct, encompassing emotional, physical, and psychosocial dimensions that cannot be understood through numerical scores alone. This methodological complementarity provides a richer, more nuanced understanding of patient-reported outcomes and highlights the value of combining approaches to inform evidence-based, person-centred care. A central question concerns what can be considered “normal” after reconstruction. Comparisons with non-operated Swedish women provide a benchmark for realistic expectations, strengthened by demographic similarity in age and BMI between groups (16). However, interviews underscored gaps in preoperative information, particularly regarding physical changes, sensory loss, and complications. Setting realistic expectations emerged as critical. A person-centred approach involving women in decision-making is essential, with nurses playing a pivotal role, not only as educators and coordinators but also as emotional supporters and advocates. Nurse-led interventions can bridge the gap between medical procedures and lived experiences by integrating psychological and practical support (35). Evidence shows that nurse-led clinics enhance satisfaction, reduce waiting times, and improve continuity of care. Comprehensive education and ongoing psychosocial support empower patients and caregivers to manage expectations, understand physical changes, and navigate emotional challenges (36). Several methodological limitations should be acknowledged when interpreting the findings. First, the relatively small sample size, drawn from a single clinic, restricts generalizability. But patients were recruited during the past year to reduce the risk of potential real bias. The underrepresentation of women with implants (less than 29% of participants) may introduce bias related to age or cancer treatment history. The survey response rate of 43% raises the possibility of selection bias, particularly among women dissatisfied with outcomes or those facing language barriers, which were not controlled for. Furthermore, interviews were conducted by telephone, which, while facilitating participation on a sensitive topic, may have reduced conversational depth and eliminated non-verbal cues. Researcher preunderstanding represents another potential limitation; clinical familiarity could have influenced both data collection and interpretation despite efforts to maintain reflexivity. Finally, integrating findings posed analytical challenges, potentially affecting the interpretation of convergent and divergent results. CONCLUSIONS This study highlights the multifaceted and highly individualized nature of women’s experiences following breast reconstruction. While many women reported a restored sense of wholeness and normality, others described persistent physical discomfort, aesthetic dissatisfaction, and unaddressed emotional needs. Nurse-led interventions, such as comprehensive education, continuity of care, and psychosocial support, are critical for bridging gaps between surgical outcomes and lived experiences. Incorporating peer support and tailored follow-up care can further strengthen patient empowerment and well-being. Future research should evaluate the long-term impact of these strategies and explore how integrated nursing models can optimize outcomes for women undergoing breast reconstruction. Declarations Ethics approval and consent to participate This study was approved by the Swedish Ethical Review Authority (2024–05864-01). Participants provided written informed consent prior to data collection. Consent for publication Not applicable Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request Competing interests The author(s) declare no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contribution MK collected, analyzed and interpreted all data and was a major contributor in writing the manuscript. CS collected and interpreted qualitative data and participated in the writing of the manuscript. JD supervised the research project and was a major contributor in writing the manuscript. All authors read and approved the final manuscript." References [Statistical database for cancer] [Internet]. 2022 [cited 2024-09-14]. Available from: https://sdb.socialstyrelsen.se/if_can/val.aspx. National Clinical Cancer Care Guidelines for Breast Cancer version 5.2 [Internet]. 2025. Available from: https://kunskapsbanken.cancercentrum.se/globalassets/cancerdiagnoser/brost/vard program/nationellt-vardprogram-brostcancer.pdf. Gašpar D, Takač I, Sobočan M. Current approaches to breast reconstruction: A scoping review of outcomes and factors influencing core outcome sets. Surg Oncol. 2025;60:102191. Roy N, Downes MH, Ibelli T, Amakiri UO, Li T, Tebha SS, et al. The psychological impacts of post-mastectomy breast reconstruction: a systematic review. Ann Breast Surg. 2024;8. Li Y, Wang C, Tan W, Jiang Y. The transition to advanced practice nursing: A systematic review of qualitative studies. Int J Nurs Stud. 2023;144:104525. El-Sabawi B, Ho AL, Sosin M, Patel KM. Patient-centered outcomes of breast reconstruction in the setting of post-mastectomy radiotherapy: A comprehensive review of the literature. J Plast Reconstr Aesthet Surg. 2017;70(6):768-80. Vincent A, Hohman MH. Latissimus Dorsi Flap. StatPearls. Treasure Island (FL): StatPearls Publishing,Copyright 2025, StatPearls Publishing LLC.; 2025. Ben Aziz M, Rose J. Breast Reconstruction Perforator Flaps. StatPearls. Treasure Island (FL): StatPearls Publishing, Copyright © 2024, StatPearls Publishing LLC.; 2024. Regan JP, Casaubon JT. Breast Reconstruction. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025. Rocco N, Catanuto GF, Accardo G, Velotti N, Chiodini P, Cinquini M, et al. Implants versus autologous tissue flaps for breast reconstruction following mastectomy. Cochrane Database Syst Rev. 2024;10(10):Cd013821. Byrne AL, Baldwin A, Harvey C. Whose centre is it anyway? Defining person-centred care in nursing: An integrative review. PLoS One. 2020;15(3):e0229923. Ghilli M, Mariniello MD, Camilleri V, Murante AM, Ferrè F, Colizzi L, et al. PROMs in post-mastectomy care: Patient self-reports (BREAST-Q™) as a powerful instrument to personalize medical services. Eur J Surg Oncol. 2020;46(6):1034-40. McCormack B, McCance T. The Person-Centred Nursing Framework. 2021. p. 13-27. Creswell JW, Clark VLP. Designing and Conducting Mixed Methods Research: SAGE Publications; 2017. Seth I, Seth N, Bulloch G, Rozen WM, Hunter-Smith DJ. Systematic Review of Breast-Q: A Tool to Evaluate Post-Mastectomy Breast Reconstruction. Breast Cancer (Dove Med Press). 2021;13:711-24. Jepsen C, Paganini A, Hansson E. Normative BREAST-Q reconstruction scores for satisfaction and well-being of the breasts and potential donor sites: what are Swedish women of the general population satisfied/dissatisfied with? J Plast Surg Hand Surg. 2023;58:124-31. O'Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy. 2008;13(2):92-8. BREAST-Q Version 2.0: A Guide for Researchers and Clinicians [Internet]. Memorial Sloan Kettering Cancer Center. 2017 [cited 2025-05-08]. Available from: https://qportfolio.org/wp-content/uploads/2018/12/BREAST-Q-USERS-GUIDE.pdf Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345-53. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753-60. Dean AG SK, Soe MM. . OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. [updated 2013/04/06. Available from: https://www.openepi.com/Menu/OE_Menu.htm. Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches: SAGE; 2023. Farmer T, Robinson K, Elliott SJ, Eyles J. Developing and implementing a triangulation protocol for qualitative health research. Qual Health Res. 2006;16(3):377-94. O'Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. Bmj. 2010;341:c4587. Kuhlefelt C, Homsy P, Repo JP, Jahkola T, Kauhanen S. Health-Related Quality of Life After Breast Reconstruction: Comparing Outcomes Between Reconstruction Techniques Using the BREAST-Q. World J Surg. 2022;46(11):2695-705. Kuhlefelt C, Repo JP, Rasi V, Meretoja T, Jahkola T, Kauhanen S, Homsy P. Preoperative reference values for breast cancer patients using the BREAST-Q. Breast. 2024;78:103832. Chen J, Duan Y, Xia H, Xiao R, Cai T, Yuan C. Online health information seeking behavior among breast cancer patients and survivors: a scoping review. BMC Womens Health. 2025;25(1):1. Kaur MN, Chan S, Bordeleau L, Zhong T, Tsangaris E, Pusic AL, et al. Re-examining content validity of the BREAST-Q more than a decade later to determine relevance and comprehensiveness. J Patient Rep Outcomes. 2023;7(1):37. Lava CX, Spoer DL, Li KR, Margulies IG, Corbett J, Berger LE, et al. Is Preoperative Happiness Influencing BREAST-Q Outcomes? Plast Reconstr Surg. 2025. Gümüscü R, Unukovych D, Wärnberg F, de Boniface J, Sund M, Åhsberg K, et al. National long-term patient-reported outcomes following mastectomy with or without breast reconstruction: The Swedish Breast Reconstruction Outcome Study Part 2 (SweBRO 2). BJS Open. 2024;8(1). Foppiani J, Lee TC, Alvarez AH, Escobar-Domingo MJ, Taritsa IC, Lee D, et al. Beyond Surgery: Psychological Well-Being's Role in Breast Reconstruction Outcomes. J Surg Res. 2025;305:26-35. Baglien BD, Ganesh Kumar N, Kennedy SH, Bekele M, Hoyte-Williams PE, Ezeome EER, Momoh AO. Normative BREAST-Q Scores in Sub-Saharan African Women: Interpreting the Impact of Mastectomy and Reconstruction. Plast Reconstr Surg Glob Open. 2025;13(2):e6495. Löfstrand J, Paganini A, Grimby-Ekman A, Lidén M, Hansson E. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg. 2024;111(1). Kamya L, Hansson E, Weick L, Hansson E. Validation and reliability testing of the Breast-Q latissimus dorsi questionnaire: cross-cultural adaptation and psychometric properties in a Swedish population. Health Qual Life Outcomes. 2021;19(1):174. Wei H, He W. A Delphi consensus for a nurse-led personalized exercise intervention in breast cancer patients during chemotherapy. BMC Nurs. 2025. Chin JC, Chen YY, Yang PS. Couples' experiences of spousal caregiving for women with breast cancer: a frame analysis. BMC Nurs. 2025;24(1):761. Additional Declarations No competing interests reported. Supplementary Files Supplementarytable1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 12 Feb, 2026 Editor assigned by journal 10 Feb, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 19 Jan, 2026 First submitted to journal 19 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8592946","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591201579,"identity":"86c8a2a7-3f11-4680-b9fb-0101d77d1e7b","order_by":0,"name":"Matilda Karlsson","email":"data:image/png;base64,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","orcid":"","institution":"Linköping University","correspondingAuthor":true,"prefix":"","firstName":"Matilda","middleName":"","lastName":"Karlsson","suffix":""},{"id":591201580,"identity":"1a0b6f4b-660d-47d1-af14-fa0cd02928bc","order_by":1,"name":"Chamiran Saume","email":"","orcid":"","institution":"Linköping University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chamiran","middleName":"","lastName":"Saume","suffix":""},{"id":591201581,"identity":"8483cd1a-638e-4875-bbb3-aef87bc95c5b","order_by":2,"name":"Jenny Drott","email":"","orcid":"","institution":"Linköping University","correspondingAuthor":false,"prefix":"","firstName":"Jenny","middleName":"","lastName":"Drott","suffix":""}],"badges":[],"createdAt":"2026-01-13 14:08:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8592946/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8592946/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102939659,"identity":"75200239-8b09-45f5-9a78-046a5e7dce07","added_by":"auto","created_at":"2026-02-18 16:57:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":157732,"visible":true,"origin":"","legend":"\u003cp\u003eJoint display showing Breast-Q mean (95 % CI) scores for the five scales. A higher score indicates higher well-being or satisfaction. Interview quotes are added to highlight quantitative data.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8592946/v1/b6570b2e6a9f2b379acae710.png"},{"id":104783710,"identity":"ee699e91-2947-4726-93f0-b5d8c9ce6a17","added_by":"auto","created_at":"2026-03-17 08:03:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1196559,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8592946/v1/1a57348e-091f-4323-9ccb-d15943d213d8.pdf"},{"id":104779098,"identity":"4df937bf-3ff2-47df-bdaa-aca41de26f4f","added_by":"auto","created_at":"2026-03-17 07:34:33","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15486,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8592946/v1/71503980db84813f5dc4f2dd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Women's Experienced Well-Being and Satisfaction after Breast Reconstruction: A Mixed-Method Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eBreast cancer is the most prevalent malignancy among women globally and in Sweden, with approximately 10,000 Swedish women diagnosed annually (1). Following breast-conserving surgery or mastectomy\u0026mdash;whether due to cancer or hereditary predisposition\u0026mdash;breast reconstruction is recommended as part of comprehensive cancer care. More than 30% of women choose to undergo reconstruction (2). Reconstruction is considered an integral component of breast cancer treatment, aiming not only to restore physical appearance but also to enhance health-related quality of life by improving body image, self-esteem, sexuality, and psychological well-being. A personalized treatment plan should be developed collaboratively by the plastic surgeon, breast surgeon, and the woman, ensuring alignment with preferences and expectations. However, reconstruction practices vary internationally (3, 4). Throughout this process, women must be well-informed, actively involved in decision-making, and supported by a multidisciplinary team, including nursing professionals and healthcare leadership(5). This approach addresses physical, psychological, and emotional needs, reflecting the principles of person-centred and evidence-based nursing care.\u003c/p\u003e \u003cp\u003eSelection of reconstruction technique depends on factors such as residual breast tissue, comorbidities (e.g., cardiovascular disease, obesity), prior or planned radiation therapy, and individual preferences. The two primary techniques are implant-based reconstruction and autologous tissue reconstruction. Autologous methods involve pedicled or free flaps, commonly harvested from the abdomen, back, gluteal, or thoracic regions (3, 6). At the current clinic, three main methods are used: Immediate implant-based reconstruction (performed concurrently with mastectomy); Delayed reconstruction using a free abdominal flap (DIEP) and Delayed reconstruction using a pedicled Latissimus Dorsi (LD) flap.\u003c/p\u003e \u003cp\u003eEach method carries specific benefits and risks. Implant-based reconstruction, while less complex, is associated with complications such as infection, implant displacement, and capsular contracture, particularly in irradiated tissue. DIEP flap reconstruction is more extensive, requiring hospitalization and close monitoring, and is contraindicated in women with obesity, smoking habits, or vascular disease. LD flap reconstruction involves shorter hospitalization and lower circulatory risk but may cause functional limitations in the shoulder region (7, 8). Delayed reconstruction is often preferred when radiation therapy is planned, as autologous tissue reduces complication rates compared to implants (9).\u003c/p\u003e \u003cp\u003eCommon postoperative complications include pain, nausea, hematoma, fat necrosis, infection, seroma, and wound dehiscence (7, 8). Women\u0026rsquo;s experiences and outcomes vary depending on surgical technique, postoperative care, and expectations. Evidence from a recent Cochrane review suggests that autologous reconstruction may offer greater psychosocial and sexual benefits (10), although consensus on the optimal method remains lacking (4).\u003c/p\u003e \u003cp\u003eUnderstanding women\u0026rsquo;s experiences and perceptions is essential, as these factors significantly influence satisfaction and long-term quality of life (4, 11). Systematic analysis of these experiences enables healthcare providers, particularly nurses, to identify critical determinants of care outcomes and implement evidence-based nursing interventions that promote person-centred care in accordance with McCormack and McCance\u0026rsquo;s framework for person-centred care (11\u0026ndash;13).\u003c/p\u003e \u003cp\u003eNurses play a pivotal role in preoperative counselling, postoperative monitoring, and ongoing psychosocial support. Evidence-based nursing interventions, such as structured information delivery, shared decision-making, and continuity of care, are essential to optimize patient outcomes and reduce unmet informational and emotional needs. This study aims to explore women's perceived well-being and satisfaction following breast reconstruction.\u003c/p\u003e \u003cp\u003eThis study seeks to address the following research questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow do women perceive and evaluate their psychosocial, sexual, and physical well-being following breast reconstruction?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the level of satisfaction among women regarding the outcomes of breast reconstruction and the adequacy of preoperative information provided?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convergent parallel mixed-methods design ( Creswell (14)) was used to address the research questions. Quantitative data were derived through the patient reported outcome instrument Breast-Q (15), and comparison with Swedish normative scores on well-being and breast satisfaction amongst women who has not undergone breast surgery (16). Qualitative data was collected through semi- structured individual interviews. This study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) framework (17).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and Study population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in a plastic surgery clinic at a university hospital in Sweden, which is an accredited Comprehensive Cancer Centre. All women (n=60), 18 years or older who underwent breast reconstruction at the clinic during 2023, were invited to participate in the study. Invitations were sent by mail, including instructions to complete a questionnaire and participate in a telephone interview. Those who consented returned the completed questionnaire together with the signed consent form. Women who agreed to be interviewed were contacted by phone. Data collections took place between October 2024 and February 2025.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe concurrent data collection of quantitative and qualitative data, as described by Creswell\u0026rsquo;s convergent parallel mixed-methods design, was chosen to comprehensively address the study aim and research questions. Quantitative data provide measurable outcomes regarding psychosocial, sexual, and physical well-being as well as satisfaction levels, while qualitative interviews capture women\u0026rsquo;s subjective experiences and contextualize these findings. Integrating data enables a deeper understanding of not only how women rate their well-being and satisfaction, but also why they perceive these outcomes as they do, thereby generating evidence that supports person-centred and evidence-based nursing practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuantitative data\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Breast-Q reconstruction module (version 2.0) (15) in an approved Swedish translation was obtained (18). The instrument is designed to evaluate outcomes after breast reconstructive surgery and is composed of several pre- and postoperative scales. Results from the following postoperative scales will be reported: psychosocial, sexual, and physical well-being related to the breast area, and satisfaction with the breast and information. Each scale contains questions answered on a Likert scale 1-4 were the higher the score the better (19). Summarized scores were converted into a rash total score from 0 (worst) to 100 (best) using conversion tables provided, quantifying the data \u0026nbsp;(18). Data collection stopped after 26 questionnaires were returned to the clinic. In addition to Breast-Q data, published Swedish normative values on well-being and satisfaction with breasts were used (16).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQualitative data\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-structured telephone interviews were conducted. The interviewers were female nurses (first and second author) with long clinical experience in caring for these patients and also experience in research. The pilot-tested interview guide included two main questions: \u0026ldquo;\u003cem\u003eCan you describe your experiences and perspectives on your health in relation to the breast reconstruction you have undergone?\u0026rdquo; and \u0026ldquo;What is your perception of the care and healthcare quality associated with the surgery?\u0026rdquo;\u003c/em\u003e. The interview guide focused on eliciting narratives concerning perceived opportunities and barriers associated with the reconstruction process, as well as different dimensions of health, including physical, psychological, social, emotional, and overall satisfaction. To deepen and clarify the participants\u0026rsquo; responses, probing techniques was used throughout the interviews, with prompts such as \u0026ldquo;Can you tell more?\u0026rdquo;, \u0026ldquo;How\u0026hellip;?\u0026rdquo;and \u0026ldquo;In what way\u0026hellip;?\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe interviews were held by one of the nurses in a quite office at the clinic and lasted between 11-42 minutes (average 21 minutes). All interviews were audio-recorded and transcribed verbatim. Eleven interviews were conducted for the qualitative part of the study. Data collection was deemed sufficient to achieve informational power, ensuring the ability to meaningfully address the research question (20).\u003c/p\u003e\n\u003cp\u003eClinical characteristics were included as; age, Body Mass Index (BMI), and documented postoperative complications were extracted for women who consented to participate. Postoperative complications included both severe complications such as postoperative bleeding and milder complications such as delayed wound healing. Further classification and description of complications are beyond the scope of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data extracted from the Breast Q, normative data and interview transcripts were initially analyzed separately and later compared and integrated in line with the method (14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuantitative analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS\u0026reg; version 30 (IBM Corporation). Categorical data were presented as frequencies (n) and percentages (%). Group differences were assessed using the Chi-square test or Fisher\u0026rsquo;s Exact Test. Continuous variables were reported as means with 95% confidence intervals (CI), following confirmation of normal distribution using the Shapiro-Wilk test. Independent samples t-tests were used for two group comparisons whilst multiple groups were analyzed using one-way ANOVA. The assumption of homogeneity of variances was verified using Levene\u0026rsquo;s test, and post hoc comparisons were performed using the Bonferroni. To facilitate comparison with previously published BREAST-Q studies, data were also analyzed using the non-parametric Kruskal-Wallis test (KWA). These results (Supplementary Table 1) were consistent with those obtained from parametric analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor comparisons with Swedish normative data, independent samples t-tests were conducted using published means and standard deviations, with calculations performed in the online statistical tool OpenEpi (21). A p-value \u0026lt; 0.05 was considered statistically significant for all analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQualitative analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interviews were analyzed inductively using qualitative content analysis (14, 22).The initial steps were carried out by the first and second authors, which read the transcripts repeatedly to gain an overall understanding of the content. The initial steps of systematically coding the data to identify initial codes were carried out independently by both authors. The findings were then discussed within the research team to strengthen trustworthiness. The themes were subsequently organized under the overarching themes represented by each Breast-Q scale, which can be seen as a deductive step in the otherwise inductive approach. According to Creswell this can be done when using established questionnaires (14). Themes without a direct link to a Breast-Q scale were assigned to the most appropriate overarching theme based on the authors\u0026rsquo; interpretation. According to Creswell, these themes represent the most important insights and are presented and discussed as silent results (14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTriangulation and Integration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResponses from each scale were used for triangulation. For psychosocial and sexual well-being, response categories were collapsed as follows: 1 = never and 2 = a few times combined into \u0026ldquo;never\u0026rdquo;; 3 = quite often remained unchanged; and 4 = almost always and 5 = all the time combined into \u0026ldquo;always.\u0026rdquo; This aligns with the response format of the module \u0026ldquo;physical well-being of the breast area\u0026rdquo; and facilitates triangulation reporting. Satisfaction was dichotomized such that \u0026ldquo;very dissatisfied\u0026rdquo; and \u0026ldquo;somewhat dissatisfied\u0026rdquo; responses were categorized as \u0026ldquo;dissatisfied,\u0026rdquo; and \u0026ldquo;somewhat satisfied\u0026rdquo; and \u0026ldquo;very satisfied\u0026rdquo; as \u0026ldquo;satisfied,\u0026rdquo; simplifying the integrated results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA triangulation protocol (23) was used to identify content areas in both analyses. This was followed by consideration of convergence, divergence, complementary, and silent results, being those that appear only in one data set (questionnaire or interview). Silent results can enhance understanding or lead to further research. Identifying divergence between methods is a vital part of this process, as exploring such differences may deepen the understanding (14, 24).\u003c/p\u003e\n\u003cp\u003eThe merged quantitative and qualitative findings are presented in continuous text. Integration is organized by the Breast Q scales (overarching themes), results from statistical analyses followed by the identified themes and response rates \u0026nbsp;(14). To illustrate identified themes, relevant quotes are included. The integrated narrative is followed by a joint display (figure 1) where overarching themes are reported alongside quantitative data and qualitative data (interview quotes). Priority (14) was given to the qualitative phase in this study as it focused on in-depth explanations of the quantitative results obtained from Breast-Q.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval from the Swedish Ethical Review Authority (reference number 2024\u0026ndash;05864-01) and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants provided written informed consent prior to data collection. The consent process emphasized the voluntary nature of participation and informed participants that they could withdraw at any time without any consequences.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTwenty-six women of the total patient population in 2023 (n=60, response rate 43%) responded to the questionnaire and twenty consented to an interview. To achieve a purposive sample representing variation in both age and type of reconstruction, eleven women were included in the interview study (Table 1). This strategic sampling aimed to ensure a breadth of experiences and perspectives within the current patient group and in line with the mixed method approach and the research questions.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Study participant characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestionnarie\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; (n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterview\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e55 (50-59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e54 (45-62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eBM \u0026nbsp; \u0026nbsp; \u0026nbsp;BMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e25 (24-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e26 (24-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eIndication for surgery\u003c/p\u003e\n \u003cp\u003eProfylactic (BRCA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;5 (19 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e2 (18 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eTherapeutic (breast cancer)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e21 (81 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e9 (82 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eRadiation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e17 (65 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;7 (64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; DIEP-flap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e10 (39 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e4 (36 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eLD \u0026ndash; flap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e11 (42 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e4 (36 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eDirect reconstruction with implants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;5 (19 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e3 (28 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003ePostoperative complications*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e12 (46 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e3 (28 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eNumbers are mean (95 % CI ) or frequency (percentage). * capsular contracture (n=1), implantat displacement (n=1), delayed wound healing (n=4), postoperative bleeding (n=3), SSI (n=2), seroma (n=1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe findings are presented in order of research questions and the five domains derived from the BREAST-Q scales and qualitative analysis: (1) psychosocial well-being, (2) sexual well-being, (3) physical well-being in the breast area, (4) satisfaction with breasts, and (5) satisfaction with information. Within each domain, quantitative and qualitative insights, highlighting areas of convergence between data sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHow do women perceive and evaluate their psychosocial, sexual, and physical well-being following breast reconstruction?\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eImpact on Psychosocial Well-Being\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe mean Breast-Q score for psychosocial well-being was 66 (59-72) (Table 2), similar to the Swedish normative score (p=0.801) (Table 3). Women with an LD flap reported significantly lower psychosocial well-being compared to those with a DIEP (p=0.018). No other significant differences were observed (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participants described in various ways how the breast reconstruction process had affected them psychologically and socially, with both positive and negative aspects. Six themes emerged: self-image, social confidence, social support, expectations, future perspectives and displeasure (due to a long waiting process).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSelf-Image\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn self-image and social confidence (convergence), survey data showed 58% accepted their bodies, 50% felt normal, and 69% always felt socially confident. Interviews confirmed these findings, with women describing feeling \u0026ldquo;whole\u0026rdquo; and \u0026ldquo;victorious\u0026rdquo; over cancer, while others struggled with disfigurement and altered body image.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;you feel more like a whole person and it\u0026rsquo;s kind of like giving the disease the finger, like saying no, I have overcome this.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 62-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"615\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Demographic data and total Breast-Q scores with respect to reconstruction type\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDIEP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eImplants\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBonferroni adjusted\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55 (50-59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54 (48-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (51-68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e45 (39-52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (24-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (23-27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (22-25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e28 (25-31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.017*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.015\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(implants-LD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWell being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Psychosocial\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66 (59-72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75 (62-87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (49-63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e69 (54-84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.018\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(DIEP-LD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Sexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44 (38-51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (34-61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41 (31-51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e45 (32-59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85 (78-92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (69-99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83 (73-93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e91 (80-102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSatisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Breast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (52-65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (41-71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60 (49-71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e60 (38-82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (49-63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (44-68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (49-68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e52 (21-82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eNumbers are means (95 % CI). * significant values\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 42.2253%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Comparison between study participants and published\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSwedish normative values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.3999%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast reconstructed women (n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWomen not breast operated\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=146)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.9439%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.9719%;\"\u003e\n \u003cp\u003emean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003emean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.9439%;\"\u003e\n \u003cp\u003ePsychosocial well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.9719%;\"\u003e\n \u003cp\u003e66 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003e66 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.9439%;\"\u003e\n \u003cp\u003eSexual well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.9719%;\"\u003e\n \u003cp\u003e44(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003e50 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.9439%;\"\u003e\n \u003cp\u003ePhysical well-being (chest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.9719%;\"\u003e\n \u003cp\u003e85 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003e98 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.9439%;\"\u003e\n \u003cp\u003ePhysical well-being\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(back and shoulders) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.9719%;\"\u003e\n \u003cp\u003e57 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003e79 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.9439%;\"\u003e\n \u003cp\u003eSatisfaction breast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.9719%;\"\u003e\n \u003cp\u003e58 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4519%;\"\u003e\n \u003cp\u003e57(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 5.928%;\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100%;\"\u003e\n \u003cp\u003e* LD module\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocial Confidence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 69% (18) reported always feeling confident in social settings and capable of doing what they wished. They felt feminine and emotionally stable. The majority (85%) reported always feeling as valuable as other women, which was also confirmed (convergence) in the interviews, where several women highlighted the positive experience of being able to wear regular clothes, feel comfortable at the public swimming pool, and not feel the need to wear prostethic breast in social contexts. Some participants expressed that the reconstruction had not affected their social life at all.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;the only difference is that I couldn\u0026rsquo;t undress in the locker room\u0026hellip; it\u0026rsquo;s different after the surgery.\u0026rdquo;\u003c/em\u003e \u003cem\u003e\u0026nbsp;\u003c/em\u003e(A 50-year-old woman who had undergone DIEP reconstruction)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocial Support\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocial support (silence) was not addressed in the questionnaire, but interviews emphasized support from partners, peers, and healthcare professionals. Several sought peer groups online for reassurance.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip;these groups have been very supportive. I am grateful they exist and that you can have a dialogue with others who are in similar situations.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 44-year-old woman who had undergone LD reconstruction)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eExpectations and future perspectives\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelated to expectations and future perspectives (silence), interviews revealed unmet expectations regarding aesthetic outcomes and a desire to move forward, contrasted by anxiety in prolonged processes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It turned out smaller than I had expected, but no\u0026mdash;I don\u0026rsquo;t have the energy to go through it again.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 41-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003cp\u003eThe Breast-Q questionnaire did not include questions regarding the women\u0026rsquo;s outlook on the future (silence), but the interviews revealed that several participants had thoughts about it. Some expressed hope and a desire to bring closure to what they experienced as a prolonged process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;You don\u0026rsquo;t really stop to think and dwell on it either. You want to move forward and move on all the time. Yes, life goes on.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 50-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003cp\u003eOthers whose process had been prolonged and complicated expressed anxiety about never feeling finished or able to accept their new body.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;but there is also anxiety. Will it be okay? Will it ever be okay?\u0026rdquo;\u003c/em\u003e\u0026nbsp; (A 42-year-old woman who had undergone implant-based reconstruction)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDispleasure after a long waiting process\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 8 of the 11 interviews, frustration was expressed over long waiting times and uncertainty about when their surgery would be performed, even though they understood that external factors such as COVID-19 could have an impact. Some described having to contact healthcare several times to get information.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I had to wait a very long time... I think I called four or five times because I felt it was taking an awfully long time\u003c/em\u003e.\u0026quot; (A 69-year-old woman who had undergone LD reconstruction)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBreast-Q does not include any questions about the overall experience of the duration of the process (silence).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.Impact on Sexual Well-Being\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score was 44 (38\u0026ndash;51), with no differences between reconstruction types or norms (p = 0.15). Half of the women reported dissatisfaction with their sex life, and 58% lacked confidence about their breast area when naked (Table 2). Interviews rarely addressed intimacy, suggesting silence despite survey signals of need.\u003c/p\u003e\n\u003cp\u003eA total of 73% (19) indicated that they never felt sexually attractive when naked. Despite this, only one informant addressed the sexual aspect, reflecting on whether a partner might have influenced her experience of the reconstruction, which is interpreted as a silence on the subject.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;if I had had a partner, I probably would have had completely different thoughts, but now I don\u0026rsquo;t have a partner I need to show myself to.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 81-year-old woman who had undergone LD reconstruction) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Impact on Physical Well-Being in the Breast Area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScores were significantly lower than norms (mean 85; p \u0026lt; 0.001), with no differences between reconstruction types (Table 2 and 3). Most women reported no persistent pain, yet tightness and movement limitations were common: 50% felt pulling, 39% reported chest muscle pain, and 35% experienced tightness. LD-specific back/shoulder scores were markedly lower than norms (mean 57 [41\u0026ndash;71], p \u0026lt; 0.001). Interviews confirmed these findings and highlighted complications (e.g., seroma, infection) that prolonged recovery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I have recovered completely, I think, and I can move however I want\u0026hellip; so it feels like my health is in good condition.\u0026rdquo;\u003c/em\u003e (A 41-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMovement Limitations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHalf (13) reported feeling some pulling in the breast area, 39% experienced pain in the chest muscles either fairly often (9) or always (1), and 35% (9) reported fairly frequent (8) or constant (1) tightness in the breast area. These experiences were also raised by participants in the interviews (confirmatory), particularly among those who had undergone LD reconstruction. In the LD-specific physical well-being scale addressing the back and shoulder, women scored significantly lower (mean 57, 41-71) than normative values (p \u0026lt; 0.001) (table 3).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I feel it stretching and pressing\u0026hellip; it tightens every time I move.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 69-year-old woman who had undergone LD reconstruction)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eComplications\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComplications impacts are not addressed in the Breast-Q (silence). The informants described recovery as long and challenging, with complications such as seroma and infection leading to frequent hospital visits and prolonged recovery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;it was more troublesome than I had expected. Recovery took longer than I anticipated.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 60-year-old woman who had undergone LD reconstruction) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWhat is the level of satisfaction among women regarding the outcomes of breast reconstruction and the adequacy of preoperative information provided?\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Satisfaction with Breasts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score was 58 (52\u0026ndash;65), similar to norms (p = 0.731). Over 80% were satisfied with breast shape when clothed, but only half were satisfied when undressed (Table 3). Interviews diverged from survey data, with most expressing dissatisfaction related to asymmetry, size differences, and unnatural appearance or sensation. Some declined corrective surgery due to treatment fatigue, while others hesitated to voice dissatisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m disfigured, you could say. It doesn\u0026rsquo;t feel much different from when I only had one breast.\u0026rdquo;\u003c/em\u003e (A 41-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003cp\u003eTwo themes were identified: asymmetry and size, and natural appearance and sensation, both reflected in the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAsymmetry and Size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifteen (58%) reported satisfaction with how symmetrical or equal their breasts were, and 17 (65%) reported satisfaction with \u0026nbsp;size. In the interviews, several described asymmetry and size differences as a significant concern, which is interpreted as a contradictory (divergence) finding. Only one woman described her breasts as symmetrical, having undergone corrective surgery. Another reported still using inserts after surgery to balance the difference.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I had expected the breasts to be more or less the same size\u0026mdash;at least to look that way when wearing clothes.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 41-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003cp\u003eSome shared their experiences with the surgeon, who saw no noticeable difference. Other women declined corrective surgery due to lack of energy. Some did not dare to openly express their feelings, having been informed about possible asymmetry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I said I knew I was warned there would be a difference between the breasts, but I thought it was a bit too big a difference. Then he looked and said he didn\u0026rsquo;t think so, but that it looked very good. But I don\u0026rsquo;t think so. Maybe I was too timid and should have said I was not satisfied, but I didn\u0026rsquo;t.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 69-year-old woman who had undergone LD reconstruction)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNatural Appearance and Sensation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFourteen women (54%) reported satisfaction with how natural their reconstructed breast looked and felt to the touch. However, in the interviews, two woman described the breast as unnatural and hard and a third expressed significant loss of sensation. The interview findings are interpreted as contradictory, as no positive experiences were reported.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There is a very big difference between the old skin that remains and the transplanted skin. If you look at it, it really is like a glued-on skin patch. But that\u0026rsquo;s only me who sees it.\u0026rdquo;\u003c/em\u003e (A 53-year-old woman who had undergone DIEP reconstruction)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Satisfaction with Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score was 56 (49\u0026ndash;64), with no differences between reconstruction types (Table 2). Surveys indicated high satisfaction with surgical information (92%), options (85%), and complications/recovery (73%). In contrast, interviews revealed insufficient counselling (divergence): consultations were perceived as brief and rushed, lacking details on postoperative appearance, drains, risks, and recovery timelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I had like a thousand questions and concerns, and they couldn\u0026rsquo;t answer them. I didn\u0026rsquo;t feel safe. I really went onto the operating table wondering what it would be like when I woke up, or what I would look like.\u0026rdquo;\u003c/em\u003e (A 42-year-old woman who had undergone implant-based reconstruction)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMore than half (53%) wanted clearer expectations for regaining normality and insight into other women\u0026rsquo;s experiences. Several sought information via social media. One positive outlier attended a clinic information evening with peer demonstrations, which strongly influenced her decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I can say that if I had known what I know today, I\u0026rsquo;m not sure I would have done it\u0026hellip; I probably would have thought twice if I had known that such complications could occur.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 69-year-old woman who had undergone LD reconstruction)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I asked if there were any pictures or anything of patients who had undergone the surgery, or how I could expect it to look\u0026hellip; I think it\u0026rsquo;s interesting to hear about others\u0026rsquo; experiences, whether they differ from my own.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(A 44-year-old woman who had undergone implant-based reconstruction)\u003c/p\u003e\n\u003cp\u003eA contradictory finding to these experiences was seen in one women\u0026rsquo;s \u0026nbsp;interview, who described an information evening at the relevant clinic she had attended as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;they were going to have an information evening where doctors talked about different reconstruction options. There were quite a few people there. They showed how it looks, people lifted their shirts and showed, including those who chose not to have reconstruction. You could say it was there and then that I decided I wanted reconstruction.\u0026rdquo;\u003c/em\u003e\u0026nbsp; (A 62-year-old woman who had undergone DIEP reconstruction)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of Integration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDivergence between surveys and interviews was most pronounced in domains of information and breast satisfaction, underscoring the complexity of patient experiences. Quantitative data suggested overall satisfaction and well-being comparable to norms, while qualitative findings exposed gaps in information, unmet expectations, and psychosocial challenges. The findings underscore a need for structured, patient-centred information strategies that go beyond procedural details to include psychosocial aspects and peer experiences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFIGURE 1 is uploaded separately in order to avoid section breaks (affecting line numbers) and to be in the correct orientation (horizontal)\u003c/strong\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis mixed-methods study provides a comprehensive understanding of women\u0026rsquo;s experiences and satisfaction following breast reconstruction, addressing both psychosocial and physical dimensions. The findings illustrate a nuanced interplay of convergent, divergent, and silent results. Importantly, previously unarticulated or silent insights- primarily emerging from the qualitative interviews and offer a deeper understanding of the women lived experiences. These insights underscore the need for evidence-based nursing interventions that prioritize individualized support. Nursing professionals hold a pivotal role in translating these findings into practice by ensuring empathetic communication, promoting continuity of care, and integrating psychosocial support throughout the reconstructive process.\u003c/p\u003e \u003cp\u003eAlthough the BREAST-Q scores indicated that psychosocial well-being in the reconstructed group was comparable to normative values, the qualitative data uncovered emotional and relational complexities. Some women reported feeling exhausted after a long unexpected reconstructive process, and worried that the process would never end, while others saw a bright future. These insights underscore the importance of discussing and measuring expectations within this group.\u003c/p\u003e \u003cp\u003eWomen who underwent LD reconstruction, who had the lowest BMI, reported significant lower psychosocial well-being scores (mean difference \u0026minus;\u0026thinsp;19 from DIEP). These findings partly contrast with previous studies, which have shown higher psychosocial well-being in women with LD and lower BMI (25, 26). This discrepancy may be due to the small sample size and timing of assessment.\u003c/p\u003e \u003cp\u003eAn important silent theme emerging from the interviews was the need for emotional support and information sharing beyond clinical facts. Women with breast cancer frequently seek information and support through digital media (27). Several participants expressed a strong desire to connect with other women who had undergone reconstruction, emphasizing that peer narratives could help set realistic expectations and ease feelings of isolation. This phenomenon is confirmed and described in an interview study, where social support is proposed as future theme in Breast-Q (28).\u003c/p\u003e \u003cp\u003eSexual well-being emerged as a consistently low-scoring domain, aligning with previous research (10, 25). While this may partly be explained by psychological distress, pain, and discomfort following breast cancer surgery (15), Jepsen\u0026rsquo;s study on normative scores suggests a broader complexity: \u0026ldquo;healthy\u0026rdquo; women in Sweden, the United States, Australia, and the Netherlands also report low sexual well-being (16). This indicates that sexual health concerns may not be solely attributable to breast cancer or reconstruction but could reflect cultural, relational, or systemic factors influencing women\u0026rsquo;s sexual experiences. Interestingly, despite low scores in the present study, only one participant spontaneously addressed the potential impact of the reconstructed breast on her sexuality. This silence may point to the sensitive nature of the topic or, more likely, to limitations in the interview guide, which lacked a direct question on sexual well-being. Future research should therefore incorporate explicit prompts to capture these nuanced experiences and inform evidence-based nursing interventions aimed at holistic recovery, including sexual health support.\u003c/p\u003e \u003cp\u003ePrevious research suggests that preoperative emotional well-being predicts postoperative sexual outcomes; women reporting happiness prior to reconstruction demonstrated significantly higher sexual well-being one year later compared to those who felt unhappy. Implant-based reconstruction has been associated with better sexual well-being than autologous techniques (29), although this finding was not replicated in the present study and lacks support from recent Cochrane evidence (10). Notably, some women experience improved sexual health following reconstruction (29), potentially linked to perceptions of the breast as integral to femininity and attractiveness. Furthermore, a Swedish study indicates that women undergoing reconstruction report superior sexual function compared to those who forgo reconstruction (30), underscoring the importance of addressing sexuality and expectations in preoperative consultations.\u003c/p\u003e \u003cp\u003ePreoperative factors such as overweight and mental health issues have been linked to poorer psychosocial and sexual well-being after reconstruction (31), highlighting the need for structured assessments and individualized preoperative evaluations. Physical well-being in the breast area was rated relatively high but remained below normative values and lower than figures reported for reconstructed Finnish women (25). Global comparisons further reveal substantial variation in physical well-being among non-operated women (32). No significant differences across reconstruction types were observed in this study, consistent with findings from a Finnish cohort (25). However, women undergoing LD reconstruction more frequently reported discomfort related to tightness and mobility, as well as reduced well-being in the back and shoulder region (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), as captured by the LD-specific module, findings corroborated by interviews and previous Swedish research (33). These results underscore the importance of procedure-specific instruments to identify concerns unique to different reconstruction techniques (34).\u003c/p\u003e \u003cp\u003eSatisfaction with the breasts among participants was comparable to that of non-operated Swedish women, suggesting that reconstruction may serve a \u0026ldquo;normalizing\u0026rdquo; function. While previous research reports higher satisfaction with autologous reconstruction compared to implants (25), this difference was not observed in the present study. Interviews revealed greater satisfaction with breast appearance when clothed than naked yet also uncovered complex and sometimes contradictory emotions. Despite relatively high Breast-Q scores, several women expressed dissatisfaction with aesthetic outcomes, particularly asymmetry, reduced size, and sensory loss. These findings highlight that questionnaires may not fully capture subjective experiences, and that satisfaction is a multifactorial construct.\u003c/p\u003e \u003cp\u003eBy integrating qualitative interviews with quantitative measures, the study demonstrates that satisfaction is a multifactorial construct, encompassing emotional, physical, and psychosocial dimensions that cannot be understood through numerical scores alone. This methodological complementarity provides a richer, more nuanced understanding of patient-reported outcomes and highlights the value of combining approaches to inform evidence-based, person-centred care.\u003c/p\u003e \u003cp\u003eA central question concerns what can be considered \u0026ldquo;normal\u0026rdquo; after reconstruction. Comparisons with non-operated Swedish women provide a benchmark for realistic expectations, strengthened by demographic similarity in age and BMI between groups (16). However, interviews underscored gaps in preoperative information, particularly regarding physical changes, sensory loss, and complications. Setting realistic expectations emerged as critical. A person-centred approach involving women in decision-making is essential, with nurses playing a pivotal role, not only as educators and coordinators but also as emotional supporters and advocates. Nurse-led interventions can bridge the gap between medical procedures and lived experiences by integrating psychological and practical support (35). Evidence shows that nurse-led clinics enhance satisfaction, reduce waiting times, and improve continuity of care. Comprehensive education and ongoing psychosocial support empower patients and caregivers to manage expectations, understand physical changes, and navigate emotional challenges (36).\u003c/p\u003e \u003cp\u003eSeveral methodological limitations should be acknowledged when interpreting the findings. First, the relatively small sample size, drawn from a single clinic, restricts generalizability. But patients were recruited during the past year to reduce the risk of potential real bias. The underrepresentation of women with implants (less than 29% of participants) may introduce bias related to age or cancer treatment history. The survey response rate of 43% raises the possibility of selection bias, particularly among women dissatisfied with outcomes or those facing language barriers, which were not controlled for. Furthermore, interviews were conducted by telephone, which, while facilitating participation on a sensitive topic, may have reduced conversational depth and eliminated non-verbal cues. Researcher preunderstanding represents another potential limitation; clinical familiarity could have influenced both data collection and interpretation despite efforts to maintain reflexivity. Finally, integrating findings posed analytical challenges, potentially affecting the interpretation of convergent and divergent results.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study highlights the multifaceted and highly individualized nature of women\u0026rsquo;s experiences following breast reconstruction. While many women reported a restored sense of wholeness and normality, others described persistent physical discomfort, aesthetic dissatisfaction, and unaddressed emotional needs. Nurse-led interventions, such as comprehensive education, continuity of care, and psychosocial support, are critical for bridging gaps between surgical outcomes and lived experiences. Incorporating peer support and tailored follow-up care can further strengthen patient empowerment and well-being. Future research should evaluate the long-term impact of these strategies and explore how integrated nursing models can optimize outcomes for women undergoing breast reconstruction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study was approved by the Swedish Ethical Review Authority (2024\u0026ndash;05864-01). Participants provided written informed consent prior to data collection.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe author(s) declare no conflict of interest.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eAuthors\u0026apos; contribution\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMK collected, analyzed and interpreted all data and was a major contributor in writing the manuscript. CS collected and interpreted qualitative data and participated in the writing of the manuscript. JD supervised the research project and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.\u0026quot;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e[Statistical database for cancer] [Internet]. 2022 [cited 2024-09-14]. Available from: https://sdb.socialstyrelsen.se/if_can/val.aspx.\u003c/li\u003e\n\u003cli\u003eNational Clinical Cancer Care Guidelines for Breast Cancer version 5.2 [Internet]. 2025. Available from: https://kunskapsbanken.cancercentrum.se/globalassets/cancerdiagnoser/brost/vard program/nationellt-vardprogram-brostcancer.pdf.\u003c/li\u003e\n\u003cli\u003eGa\u0026scaron;par D, Takač I, Sobočan M. Current approaches to breast reconstruction: A scoping review of outcomes and factors influencing core outcome sets. 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Online health information seeking behavior among breast cancer patients and survivors: a scoping review. BMC Womens Health. 2025;25(1):1.\u003c/li\u003e\n\u003cli\u003eKaur MN, Chan S, Bordeleau L, Zhong T, Tsangaris E, Pusic AL, et al. Re-examining content validity of the BREAST-Q more than a decade later to determine relevance and comprehensiveness. J Patient Rep Outcomes. 2023;7(1):37.\u003c/li\u003e\n\u003cli\u003eLava CX, Spoer DL, Li KR, Margulies IG, Corbett J, Berger LE, et al. Is Preoperative Happiness Influencing BREAST-Q Outcomes? Plast Reconstr Surg. 2025.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;m\u0026uuml;sc\u0026uuml; R, Unukovych D, W\u0026auml;rnberg F, de Boniface J, Sund M, \u0026Aring;hsberg K, et al. National long-term patient-reported outcomes following mastectomy with or without breast reconstruction: The Swedish Breast Reconstruction Outcome Study Part 2 (SweBRO 2). BJS Open. 2024;8(1).\u003c/li\u003e\n\u003cli\u003eFoppiani J, Lee TC, Alvarez AH, Escobar-Domingo MJ, Taritsa IC, Lee D, et al. Beyond Surgery: Psychological Well-Being\u0026apos;s Role in Breast Reconstruction Outcomes. J Surg Res. 2025;305:26-35.\u003c/li\u003e\n\u003cli\u003eBaglien BD, Ganesh Kumar N, Kennedy SH, Bekele M, Hoyte-Williams PE, Ezeome EER, Momoh AO. Normative BREAST-Q Scores in Sub-Saharan African Women: Interpreting the Impact of Mastectomy and Reconstruction. Plast Reconstr Surg Glob Open. 2025;13(2):e6495.\u003c/li\u003e\n\u003cli\u003eL\u0026ouml;fstrand J, Paganini A, Grimby-Ekman A, Lid\u0026eacute;n M, Hansson E. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg. 2024;111(1).\u003c/li\u003e\n\u003cli\u003eKamya L, Hansson E, Weick L, Hansson E. Validation and reliability testing of the Breast-Q latissimus dorsi questionnaire: cross-cultural adaptation and psychometric properties in a Swedish population. Health Qual Life Outcomes. 2021;19(1):174.\u003c/li\u003e\n\u003cli\u003eWei H, He W. A Delphi consensus for a nurse-led personalized exercise intervention in breast cancer patients during chemotherapy. BMC Nurs. 2025.\u003c/li\u003e\n\u003cli\u003eChin JC, Chen YY, Yang PS. Couples\u0026apos; experiences of spousal caregiving for women with breast cancer: a frame analysis. BMC Nurs. 2025;24(1):761. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast Reconstruction, Evidence-Based Nursing, Mixed-methods, Patient Satisfaction, Postoperative care, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-8592946/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8592946/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBreast cancer is the most common malignancy among women in Sweden. Breast reconstruction, recommended after breast-conserving surgery or mastectomy, is chosen by over 30% of patients and aims to improve quality of life beyond restoring appearance. Despite its recognized role in cancer care, evidence on women\u0026rsquo;s experiences and satisfaction remains limited. This study addresses this gap by exploring perceived well-being and satisfaction following reconstruction.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA convergent parallel mixed-methods design was applied. The study was conducted at a university hospital plastic surgery clinic between October 2024 and February 2025. All women (\u0026ge;\u0026thinsp;18 years) who underwent breast reconstruction in 2023 were invited, and 43% of them were included. Quantitative data were collected using the questionnaire Breast-Q and qualitative data were obtained through semi-structured interviews.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwenty-six women completed the questionnaire, and twenty participated in interviews. Psychosocial and sexual well-being, as well as breast satisfaction, were generally comparable to normative levels, suggesting a potential \u0026ldquo;normalizing\u0026rdquo; effect of reconstruction. Participants frequently described feeling socially secure, feminine, and attractive. However, many reported sexual insecurity, disappointment, and fatigue following surgery. Although overall breast satisfaction was high, asymmetry emerged as a source of dissatisfaction. Physical well-being scored below normative values, often due to functional limitations. Despite predominantly positive outcomes, a pronounced need for improved information and guidance remained.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBreast reconstruction appears to support psychosocial recovery and body image normalization, yet challenges related to physical limitations and sexual well-being persist. These findings underscore the importance of evidence-based nursing and comprehensive pre- and postoperative counselling. Enhanced patient education and individualized support may improve satisfaction and overall quality of life.\u003c/p\u003e","manuscriptTitle":"Women's Experienced Well-Being and Satisfaction after Breast Reconstruction: A Mixed-Method Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 16:57:00","doi":"10.21203/rs.3.rs-8592946/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-12T11:09:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-10T07:05:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T07:06:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T06:53:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-01-19T06:44:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a129d51-c7fc-4f14-a608-77d8f39d40d1","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T16:57:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 16:57:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8592946","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8592946","identity":"rs-8592946","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}