Are Expectations in Breast Reconstruction Manageable? A Mixed-Methods GoBreast II Study on Women's Goals of Breast Reconstruction After Mastectomy

INTRODUCTION: Breast reconstruction aims to improve quality of life after mastectomy, but women's underlying goals vary widely and are often complex. Limited research has explored how these goals differ according to indication for mastectomy, timing of reconstruction, or reconstructive technique. Understanding patients' goals is essential for shared decision-making, managing expectations, and improving patient satisfaction. METHODS: This cross-sectional mixed-methods study included women undergoing breast reconstruction within the preference arm of the GoBreast II trial at a Swedish university hospital. Participants completed a preoperative PEGASUS (Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) consultation to identify individual goals. Goals were analyzed using inductive qualitative content analysis and quantified by category frequency. Comparisons were made between reconstructive technique (autologous vs. implant-based), timing (immediate vs. delayed), and indication for mastectomy (therapeutic vs. risk-reducing). RESULTS: Eighty-nine women were included (median age 48 years). Five main goal categories were identified: Achieving a feeling, just wanting the breast back, Aesthetic wishes, Practical matters, and the process. Women opting for implant-based reconstruction expressed more aesthetic goals than those choosing autologous reconstruction. Patients undergoing delayed reconstruction reported more goals related to practical matters. Women undergoing risk-reducing mastectomy expressed more aesthetic wishes and fewer practical concerns than women treated for breast cancer. CONCLUSIONS: Women's goals for breast reconstruction extend beyond physical restoration and include emotional, identity-related, and aesthetic dimensions. Structured identification of patient goals may improve preoperative counselling, shared decision-making, and management of expectations in breast reconstruction.