高达 40% 的女性在乳房再造后因与个人喜好不一致的意外结果而感到不满意。确定患者在考虑手术时看重哪些属性可以改善共同决策。基于自适应选择的联合 (ACBC) 分析可以得出个人水平的治疗偏好。确定乳房重建的哪些属性对于考虑手术的女性最重要，并描述这些属性对于那些喜欢皮瓣重建和植入物重建的女性有何不同。该网络-基于横断面的研究于2022年3月1日至2023年1月31日在杜克大学进行，并于2022年6月1日至12月31日期间通过Love Research Army与ACBC分析进行。参与者包括杜克大学 105 名新诊断出乳腺癌或有乳腺癌遗传倾向且正在考虑乳房切除术和重建的女性，以及 301 名有乳腺癌病史或通过 Love Research Army 登记处确定有遗传倾向的女性。相对重要性评分，总体而言，406 名女性（105 名来自杜克大学 [平均 (SD) 年龄，46.3 (10.5) 岁] 和 301 名来自爱情研究军登记处 [平均 (SD) 年龄， 59.2（11.9）年]）参加了。最重要的属性是腹部发病风险（平均 [SD] 相对重要性 [RI]，28% [11%]），其次是主要并发症的几率（RI，25% [10%]）、额外并发症的数量手术（RI，23% [12%]）、乳房外观（RI，13% [12%]）和恢复时间（RI，11% [7%]）。大多数参与者 (344 [85%]) 更喜欢基于种植体的重建；这些参与者最关心腹部发病率（平均 [SD] RI，30% [11%]），其次是并发症的风险（平均 [SD]，RI，26% [11%]）和额外手术（平均 [SD] RI，26% [11%]） ] RI，21% [12%]）。相比之下，选择皮瓣重建的参与者最关心的是额外手术（平均 [SD] RI，31% [15%]）、乳房外观（平均 [SD] RI，27% [16%]）以及手术风险。并发症（平均 [SD] RI，18% [6%]）。与选择皮瓣重建独立相关的因素包括已婚（比值比 [OR]，2.30 [95% CI，1.04-5.08]；P = .04）和较高的教育水平（大学教育；OR，2.43 [95% CI，1.01] -5.86]；P = .048），而收入水平高于 75000 美元则与选择皮瓣轮廓的可能性降低相关（OR，0.45 [95% CI，0.21-0.97]；P = .01） 。喜欢皮瓣外观的受访者愿意接受腹部发病率平均 (SD) 增加 14.9% (2.2%) (n = 113) 或并发症 (n = 115) 6.4% (4.8%) 的可能性。这项研究提供有关女性在做出乳房重建决定时如何重视其护理的不同方面的信息。未来的研究应该评估引发个人偏好的决策辅助工具如何帮助定制患者与医生的讨论，将术前咨询重点放在对每个患者最重要的因素上，并最终改善以患者为中心的护理。

Up to 40% of women experience dissatisfaction after breast reconstruction due to unexpected outcomes that are poorly aligned with personal preferences. Identifying what attributes patients value when considering surgery could improve shared decision-making. Adaptive choice-based conjoint (ACBC) analysis can elicit individual-level treatment preferences.To identify which attributes of breast reconstruction are most important to women considering surgery and to describe how these attributes differ by those who prefer flap vs implant reconstruction.This web-based, cross-sectional study was conducted from March 1, 2022, to January 31, 2023, at Duke University and between June 1 and December 31, 2022, through the Love Research Army with ACBC analysis. Participants were 105 women at Duke University with a new diagnosis of or genetic predisposition to breast cancer who were considering mastectomy with reconstruction and 301 women with a history of breast cancer or a genetic predisposition as identified through the Love Research Army registry.Relative importance scores, part-worth utility values, and maximum acceptable risks were estimated.Overall, 406 women (105 from Duke University [mean (SD) age, 46.3 (10.5) years] and 301 from the Love Research Army registry [mean (SD) age, 59.2 (11.9) years]) participated. The attribute considered most important was the risk of abdominal morbidity (mean [SD] relative importance [RI], 28% [11%]), followed by chance of major complications (RI, 25% [10%]), number of additional operations (RI, 23% [12%]), appearance of the breasts (RI, 13% [12%]), and recovery time (RI, 11% [7%]). Most participants (344 [85%]) preferred implant-based reconstruction; these participants cared most about abdominal morbidity (mean [SD] RI, 30% [11%]), followed by the risk of complications (mean [SD], RI, 26% [11%]) and additional operations (mean [SD] RI, 21% [12%]). In contrast, participants who preferred flap reconstruction cared most about additional operations (mean [SD] RI, 31% [15%]), appearance of the breasts (mean [SD] RI, 27% [16%]), and risk of complications (mean [SD] RI, 18% [6%]). Factors independently associated with choosing flap reconstruction included being married (odds ratio [OR], 2.30 [95% CI, 1.04-5.08]; P = .04) and higher educational level (college education; OR, 2.43 [95% CI, 1.01-5.86]; P = .048), while having an income level of greater than $75 000 was associated with a decreased likelihood of choosing the flap profile (OR, 0.45 [95% CI, 0.21-0.97]; P = .01). Respondents who preferred flap appearance were willing to accept a mean (SD) increase of 14.9% (2.2%) chance of abdominal morbidity (n = 113) or 6.4% (4.8%) chance of complications (n = 115).This study provides information on how women value different aspects of their care when making decisions for breast reconstruction. Future studies should assess how decision aids that elicit individual-level preferences can help tailor patient-physician discussions to focus preoperative counseling on factors that matter most to each patient and ultimately improve patient-centered care.