Choosing Not to Have Reconstruction
One of the more difficult choices facing women who need or opt for a mastectomy (or bilateral mastectomies) is whether or not to have reconstruction. Increasingly, women prefer to have reconstruction, and it sometimes can feel as though there really is not another option. At least at our hospital, our breast surgeons tend to say something like: "I am sorry that you need a mastectomy, but you can find reconstruction at the same time." One of my ongoing campaigns is to change that sentence to: "I am sorry that you need a mastectomy. We can talk more about whether you want reconstruction and, if so, how to learn about your choices."
I firmly believe that women make the best decisions for themselves, and I always support a woman's choice as well as her right to choose. I also firmly believe that many women are not fully informed about all that reconstruction entails and about the range of choices (and, yes, it usually seems that none of them are very good choices) available. The best article I have ever read about reconstruction was from The New York Times several months ago. Here is a link to the blog that I wrote about it: http://www.bidmc.org/YourHealth/BIDMCInteractive/Blogs/LivingwithBreastCancer/2013/July/Breast-Reconstruction-Options.aspx
In that blog, I mention this terrific site with a great deal of information about the no reconstruction option: http://www.breastfree.org/
Today's new addition is this article from Springer Plus about the reasons women may opt not to have reconstruction. They boil down to a wish to avoid additional surgery and adequate comfort with a changed body. Here is the abstract and a link to read more:
Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients
Delphine Héquet1, Kevin Zarca2, Sylvie Dolbeault3, Benoît Couturaud1, Charlotte Ngô1, Virgine Fourchotte1,
Anne De La Rochefordière3, Jean-Guillaume Féron1, Alfred Fitoussi1, Catherine Bélichard1, Fabien Reyal1,
Fatima Laki1, David Hajage2, Brigitte Sigal4, Bernard Asselain2, and Séverine Alran1,5* Institut Curie Breast Cancer Group, Roman Rouzier
Background: The aims of the study were to investigate the factors associated with not having breast
reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction.
Patients and methods: We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients.
Results: The proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction.
For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients.
Conclusion: Better understanding the factors that influence decision of nonreconstruction can help us adapt the
information to serve the patient’s personal needs.