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Women’s Experiences With Flap Failure After Autologous Breast Reconstruction: A Qualitative Analysis

Higgins, Kristen S. BScH*; Gillis, Joshua MD; Williams, Jason G. FRCSC; LeBlanc, Martin FRCSC; Bezuhly, Michael MD, MSc, SM, FRCSC; Chorney, Jill M. PhD*‡

doi: 10.1097/SAP.0000000000000910

Clinical experience suggests that flap failure after autologous breast reconstruction can be a devastating experience for women. Previous research has examined women's experiences with autologous breast reconstruction with and without complications, and patients' experiences with suboptimal outcomes from other medical procedures. The authors aimed to examine the psychosocial experience of flap failure from the patient's perspective. Seven women who had experienced unilateral flap failure after deep inferior epigastric perforator flap surgery in the past 12 years completed semistructured interviews about their breast cancer treatments, their experiences with flap failure, the impact of flap failure on their lives, and the coping strategies they used. Interpretive phenomenological analysis, a type of qualitative analysis that provides an in-depth account of participant’s experiences and their meanings, was used to analyze the interview data. From these data, patient-derived recommendations were developed for surgeons caring for women who have experienced flap failure. Three main themes (6 subthemes) emerged: coming to terms with flap failure (coping with emotions, body dissatisfaction); making meaning of flap failure experience (questioning, relationship with surgeon); and care providers acknowledging the emotional experience of flap failure (experience of being treated “mechanically,” suggestions for improvement). In conclusion, flap failure in breast reconstruction is an emotionally difficult experience for women. Although there are similarities to other populations of patients experiencing suboptimal outcomes from medical procedures, there are also unique aspects of the flap failure experience. A better understanding of women's experiences with flap failure will assist in providing more appropriate supports.

From the Departments of *Psychology & Neuroscience, †Division of Plastic & Reconstructive Surgery, Department of Surgery, and ‡Department of Anesthesia, Pain Management and Perioperative Medicine IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.

Received March 25, 2016, and accepted for publication, after revision August 10, 2016.

Conflicts of interest and sources of funding: none declared.

Reprints: Michael Bezuhly, MD, MSc, SM, FRCSC, Division of Plastic and Reconstructive Surgery, Dalhousie University, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, Nova Scotia, Canada B3K 6R8. E-mail:

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