Some women not told about breast reconstruction

NEW YORK (Reuters Health) - Doctors don’t universally discuss the option of breast reconstruction with all women undergoing mastectomy, results of a new study confirm.

Doctors are most apt to have these conversations with younger, more educated white women, than with older, less educated, Hispanic women, Dr. Caprice C. Greenberg, from Brigham and Women’s Hospital, Boston, and colleagues found. Prior studies have shown that women who are not privy to these conversations are less likely to undergo breast reconstruction.

“Women need to know all the facts about breast reconstruction,” Greenberg noted in a telephone interview with Reuters Health, “and if your physician doesn’t bring it up, women should be proactive and not afraid to ask if reconstruction is an option if they do need a mastectomy.”

Greenberg also noted that in the majority of instances, breast reconstruction is performed at the same time as mastectomy. “It’s all done in one procedure, so it is absolutely important to discuss it before hand.”

In a review of 626 women with breast cancer who underwent mastectomy, Greenberg and colleagues found that 253 (40.4 percent) also had breast reconstruction. In 249 women (39.8 percent), the medical records documented that the doctor discussed breast reconstruction with the patient.

Roughly 70 percent of women who had a discussion about breast reconstruction with their doctor opted for reconstruction. As mentioned, younger, more educated, Caucasian women who were not overweight or receiving radiation therapy after mastectomy were more likely than other women to have breast reconstruction and more likely to have had a conversation about it with their doctor.

The researchers also found that breast reconstruction was less likely if the patient was older, Hispanic or born outside the US, even if they had had a conversation with their doctor about post-mastectomy breast reconstruction.

“Although decisions about reconstruction after mastectomy should rest primarily on clinical considerations,” this study, like others, has shown variation in the likelihood of reconstruction according to age, education, and race, Greenberg and colleagues note in the Journal of the American College of Surgeons.

“Breast reconstruction is purely an elective procedure and it’s not for everybody,” Greenberg said. “Doctors have to take clinical factors into account; your physician may say you are not a candidate for immediate reconstruction but that discussion should happen with everybody.”

SOURCE: Journal of the American College of Surgeons, April 2008.