Information about Reconstruction
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
MAY 15, 2017
This study from JAMA Surgery, as reported by BreastCancer.Org, does not surprise me at all. Yes, it is unclear how widely this single study can be understood to apply. The numbers are small, and all of the surveyed women were treated at a single hospital in North Carolina. Could the results be very different at other institutions, in other parts of the country? Of course. However, without ever doing a study, I would guess that our numbers are not so different, and I have strong suspicious that would be true just about everywhere.
The finding was that more than half of women who had a mastectomy did not end up with a reconstruction choice that matched their preferences. That is, some did not have reconstruction when they would have preferred to do so (and, yes, there could be medical reasons for that), and some had reconstruction when they would have preferred not to do so.
Here, our wonderful breast surgeons are committed to offering women the best possible results--meaning to sustain their health and to have decent cosmetic results and to respect their preferences. However, it seems that usually the conversation goes something like this: "Ms. X, I am sorry that you need a mastectomy, but you can have reconstruction at the same time." This is exactly right for some women, but exactly wrong for others. And it is pretty hard to think straight and maybe even push back in the midst of a diagnosis. None of us are thinking our best in those first days.
I do find that just about everyone makes peace with whatever she has chosen. Of course, in many cases, you don't really have a choice about that. What's done is done. However, I too often hear from women who do not feel they were well informed about the realities of their reconstruction choice, were unhappily surprised by the intensity or numbers of surgeries, by pain, by sometimes less than optimal cosmetic results. Please remember that many women are very happy with the outcome, but I surely wish there were a way to be sure that women understand their options, have a chance to think carefully about them, and are supported in their decisions.
Here is the start of the article and then a link to read more:
More Than Half of Women Don’t Get Enough Information About Reconstruction From Surgeons
Many, but not all, women who have mastectomy to treat breast cancer go on
to have one or both breasts reconstructed.
There are many ways to reconstruct a breast. Tissue from the back, belly, buttocks, or other part of the body can be used to create a new breast. Doctors call this autologous reconstruction. Saline or silicone gel implants are another option.
Like any surgery, breast reconstruction has both benefits and risks. Breastcancer.org recommends that you talk to all of your cancer doctors and your plastic surgeon about the best options for your unique situation. When you have all the information, you can make a decision that is right for you and your personal preferences.
Still, it seems that many surgeons aren’t giving women enough information about breast reconstruction.
A very small study suggests that more than half of women who had mastectomy made a reconstruction decision that didn’t align with their goals and preferences.
The study was published online on May 3, 2017 by JAMA Surgery. Read the abstract of “Quality of Patient Decisions About Breast Reconstruction After Mastectomy.”
It’s important to know that this study was very small only 126 women participated. Also, the women were all treated at the same institution, the North Carolina Cancer Hospital. So it’s not clear how widely the results can be applied.