Choices in Breast Reconstruction
I have written a number of times, from a range of perspectives, about the choices related to breast reconstruction. I strongly believe that every woman having a mastectomy (or bilateral mastectomies) should be given the necessary information to make the choice that is right for her. This covers a number of possibilities: no reconstruction, a delayed decision with possible reconstruction later, or immediate reconstruction either using expanders/implants or one of a number of flap surgeries. Unless a woman is completely sure that she does not want reconstruction, she should meet with a plastic surgeon to learn more about the options and make a better informed decision.
Here is my current pet peeve: At some institutions, including sometimes our own, the mastectomy/reconstruction plan is presented as a single possibility -- e.g. "You will need a mastectomy, but you can have reconstruction at the same time." I think this is a mistake as no newly diagnosed woman is at her emotional or cognitive best, and this can start a chain of appointments and events that take on a life of their own. Although almost all women are eventually satisfied with the choice they have made, I surely have heard women lament the pressure of this decision period, and the retrospective sense that they were pushed in one or another direction at a time they could not advocate too well for themselves.
In addition to meeting with a plastic surgeon, I think that all women considering reconstruction should also be given the chance to speak with other women who have made the same or a different decision. As we all know, you always hear something different from the patient than from the doctor. If you are in the midst of this turmoil, please contact me, and I can put you in touch with other thoughtful women who have made a range of choices.
This is the best website with information about no reconstruction: www.breastfree. org
And this is an article, that stimulated today's entry, about reconstruction choices made by a cohort of women at Washington University in St Louis. Here is the abstract and then a link to read more:
Reconstruction Patterns in a Single Institution Cohort of Women Undergoing Mastectomy for Breast Cancer
Leisha Elmore, BS; Terence M. Myckatyn, MD; Feng Gao, PhD; Carla S. Fisher, MD; Jordan Atkins, BS; Tonya M. Martin-Dunlap, MD; and Julie A. Margenthaler, MD, FACS
Objectives. The purpose of the current study was to conduct a patient-centered investigation of reconstruction practices following mastectomy at our institution.
Methods. A questionnaire was administered to patients who underwent unilateral or bilateral mastectomy for breast cancer from 2006 to 2010. The survey queried on demographics, surgical choices, and rationale for those choices. Data were summarized by contingency tables and compared by chi-square test or Fisher's exact test, as appropriate.
Results. Of 321 patients queried, 185 (58 %) underwent unilateral mastectomy and 136 (42 %) underwent bilateral mastectomy (mean age 56 ± 12 years). Overall, 189 (59 %) women underwent breast reconstruction, and 132 (41 %) did not. Immediate breast reconstruction was performed in 125 of 189 (69 %) women, whereas 67 of 189 (31 %) underwent delayed reconstruction. The method of definitive reconstruction included 143 of 189 (75 %) prostheses, 32 of 189 (17 %) abdominal tissue flap, 12 of 189 (6 %) latissimus flap (±implant), and 5 of 189 (2 %) with a combination of prostheses and tissue flaps. Of the 114 patients who did not undergo reconstruction, 68 (60 %) reported lack of desire for reconstruction as their motive, and the remaining 46 (40 %) reported medical contraindications for reconstruction or did not report a specific reason.
Conclusions. A significant percentage of women undergoing unilateral or bilateral mastectomy for breast cancer at our institution elect to undergo reconstruction. Prosthetic reconstruction was the most common method utilized. The impetus for referral to the reconstructive surgeon was nearly always initiated by the surgical oncologist.
Read more »