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    Most Don't Rebuild Breast After Cancer

    Rates of Reconstructive Surgery Vary Greatly Among Ethnic Groups and Regions

    Patient Preference, Doctor Bias

    Certainly, some women who are offered reconstructive surgery chose not to have it. This is especially true among older women.

    Roughly three out of four breast cancer patients in the U.S. are age 50 or older at diagnosis. Yet less than half of breast reconstruction surgeries are performed on patients age 50 and older, and fewer than one in 12 reconstructive surgery patients are over age 64.

    "It may be that older women have different priorities that drive their decision, and that there are cultural and social differences that make African-Americans half as likely to want reconstructive surgery," Alderman says.

    "But it may also be that these women aren't being offered the surgery because of physician bias."

    She says many general surgeons may still believe that reconstructive surgery makes it harder to identify cancer recurrences, even though studies have shown that this is not the case.

    There may also be more reconstructive surgeons in some regions of the country than in others, she says, which might help explain regional differences.

    Albany, Ga., plastic surgeon Walter Erhardt, MD, tells WebMD that advances in reconstructive surgery should make it a more attractive option for breast cancer patients in the future.

    More and more general surgeons are performing skin-sparing mastectomies, for example, that make it much easier to reconstruct the breast.

    "This is one of the biggest changes that I have seen," he says. "As more general surgeons begin doing this we may see the reconstruction rates go up."

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