Advice lacking on reconstruction after mastectomy

NEW YORK (Reuters Health) - "Surprisingly" few women having mastectomy for breast cancer are referred by their general surgeon to a plastic surgeon to discuss reconstruction options, results of a survey suggest.

"There are a lot of psychological benefits of breast reconstruction for women who want it, yet it is significantly underused," Dr. Amy Alderman, an assistant professor of plastic surgery at the University of Michigan, Ann Arbor, noted in a telephone interview with Reuters Health.

It's estimated that only 16 percent of mastectomy patients undergo breast reconstruction. The current survey suggests that doctors need to do a better job of informing breast cancer patients about breast reconstruction, Alderman said.

Among 365 general surgeons from Detroit and Los Angeles who responded to a survey regarding breast reconstruction, 44 percent said they referred less than a quarter of eligible women to plastic surgeons for reconstruction.

Only 24 percent said they referred three-quarters or more of their mastectomy patients for breast reconstruction, Alderman and colleagues report in the journal Cancer.

"I was surprised by how few surgeons referred mastectomy patients to plastic surgeons for reconstruction," Alderman said, given that the US government passed a law nearly a decade ago that mandates insurance coverage for breast reconstruction.

Female surgeons, surgeons who performed more than 50 mastectomies annually, and surgeons whose offices were located in cancer centers were most likely to refer mastectomy patients to plastic surgeons for breast reconstruction.

"Low-referral" surgeons cited inadequate knowledge by women, high cost of reconstruction, and unavailability of plastic surgeons as reasons for not referring mastectomy patients for reconstructive surgery. Many surgeons also felt breast reconstruction was of little concern to women compared to other aspects of their breast cancer care.

"Women should be given information on breast reconstruction and it looks like they are not," Alderman concluded. "If a woman is interested in breast reconstruction, she should bring it up with her general surgeon," she advised.

SOURCE: Cancer, May 1, 2007.