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Address Reconstruction in Discussions About Breast Cancer Surgery

Women who discussed reconstruction with their surgeons were significantly more likely to undergo mastectomy than women who did not have such counsel.

Although surgical decision making about breast-conserving surgery (BCS) versus mastectomy has been studied extensively, we know less about the nature of guidance provided by clinicians regarding breast reconstruction and how such counsel affects the choices of women with newly diagnosed breast cancer. Investigators surveyed women who had undergone surgery for ductal carcinoma in situ or invasive breast cancer and who were eligible at diagnosis to choose between BCS and mastectomy. Among approximately 1200 respondents (mean age, 59), 71% were white, 20% were black, and 65% had at least some college education.

One third of respondents reported that their general surgeons had discussed breast reconstruction with them. Women who had such discussions were significantly younger and more educated but were of similar racial distribution as those who did not. Women who reported discussing reconstruction with their surgeons were more than four times as likely to undergo mastectomy as were respondents who did not have such discussions.

Comment: To say that surgical decision making in the setting of newly diagnosed breast cancer is complex is an understatement. BCS is associated with a much more rapid return to full activities than is mastectomy with reconstruction. Reconstructions performed at the time of mastectomy are associated with better aesthetic and emotional outcomes than are delayed procedures. However, stage and size of tumor, need for radiation therapy, and comorbidities such as obesity and smoking all must be considered in deciding whether immediate reconstruction is appropriate.

Unfortunately, the authors do not provide the actual percentages of women opting for mastectomy in each group, so the between-group difference is difficult to interpret (and could be narrow). Furthermore, the investigators could not determine whether discussions about reconstruction were initiated by patients or by surgeons — also, patients’ recall of preoperative discussions might vary over time and be affected by their treatment experiences. Despite these caveats, the results point to the importance of counsel as well as plastic surgery referral for women with recently diagnosed breast cancer who are candidates for mastectomy.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health February 28, 2008

Citation(s):

Alderman AK et al. Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. Cancer 2007 Dec 21; [e-pub ahead of print]. (http://dx.doi.org/10.1002/cncr.23214)