OBJECTIVES: Surgery for breast cancer has a substantial impact on a woman’s health-related quality of life (HR-QOL). The NIH and EORTC advocate treatment with breast conserving therapy (BCT) for women with early stage breast cancer. The aim of this study was to understand the shared surgical decision-making process from the patients’ perspective by implementing qualitative methods. METHODS: All participants were recruited and consented from a single center. Inclusion criteria included women who selected BCT over mastectomy. Utilizing an interview guide, women were asked to share their experience with all aspects of decision-making related to breast cancer treatment. Interviews were audio-taped, transcribed, and coded with NVIVO8. Qualitative data were further analyzed to identify factors influencing decision-making regarding BCT. A comparative matrix analysis was conducted to further evaluate women’s appraisal of their surgical decision-making process and how this impacted their long-term HR-QOL. RESULTS: Nineteen patients were included in the analysis. The mean age was 58.3 (+ 12.2) years, 52.9% were married, 84.2% were Caucasian, 68.4% were currently employed and 31.6% had a family history of breast cancer, 10.4% diagnosed with Stage 0, 52.6% stage I and 36.8% stage II breast cancer. Factors contributing to decision-making were dichotomized into satisfied (n=11) or dissatisfied (n=8). Satisfied patients were further categorized as either (i) positive outlook n= 2; (ii) acceptance of choice n= 9; Dissatisfied patients were further categorized as (i) experiencing regret n=4; (ii) fear of recurrence n=4. CONCLUSIONS: As decision-making needs vary by individual women, a personalized decision-making approach is an essential factor to improve HR-QOL among women with early stage breast cancer. Additional prospective quantitative studies of the preoperative decision-making and post-operative HR-QOL are necessary, as these findings may compliment existing outcomes research.