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Breast Cancer: Know the Surgery Options

Study Shows Many Patients Aren't Told About Breast Reconstruction
By
WebMD Health News
Reviewed by Louise Chang, MD

Breast Reconstruction Not Discussed

Dec. 21, 2007 -- Most women facing breast cancer surgery are not told that mastectomy with breast reconstruction is an option, a new study shows.

Researchers surveyed almost 1,200 early-stage breast cancer patients eligible for breast-conserving lumpectomy or mastectomy.

They found that only one in three were told by their general surgeon that breast reconstruction was an option.

Patients who did have the discussion with their surgeon were four times more likely to choose breast removal over lumpectomy.

Studies show that survival rates are the same among early-stage breast cancer patients, whether they have breast-conserving surgery with radiation or mastectomy.

Plastic surgeon Amy Alderman, MD, who led the study team, says women need to be fully informed of their surgical choices before they decide on a treatment course.

"The point is we have three great surgical choices -- lumpectomy, mastectomy, and mastectomy with reconstruction," she says. "There are pros and cons to each of these choices, and we as physicians have a responsibility to help patients understand this."

Surgical Choices

Alderman says mastectomy with breast reconstruction often results in better cosmetic outcomes than breast-conservation surgery.

"I see a lot of patients who are quite unhappy with their cosmetic appearance after the lumpectomy and I can't do anything about it after they have had radiation," she says.

The women included in the University of Michigan Medical Center study all had surgery for stage I, stage II, or stage III breast cancer around 2002.

Only 33% said they discussed breast reconstruction with their general surgeon during the initial surgical decision-making process.

Younger patients and more highly educated patients were more likely to be told about breast reconstruction.

Female surgeons and those who worked in cancer centers were the most likely to discuss mastectomy with breast reconstruction, says Alderman.

The study will be published in the Feb. 1, 2008 issue of the journal Cancer.

 

Presenting the Options

Oncologist Otis Brawley, MD, tells WebMD that cancer specialists may be better equipped than general surgeons to present all the options to breast cancer patients.

Brawley serves as chief medical officer for the American Cancer Society and is a professor of oncology and hematology at Emory University in Atlanta.

"A general surgeon may do one breast cancer surgery a month, and is probably less likely to have a relationship with a plastic surgeon," he says.

Brawley says the study shows that women who are fully informed about their surgical options may not always chose breast- conserving lumpectomies.

Mastectomy with reconstruction may be the best option for women who want to avoid radiation and for those who fear that anything less than total breast removal will increase the chances that their cancer will recur.  

"It is important that [mastectomy with] reconstruction not be forced on anyone, but women facing this decision need to know about it," he says.

But he isn't optimistic that the new study will lead to major changes.

"One paper usually doesn't change medical practice, but I hope it will alert women with breast cancer, breast cancer support groups, and internists who take care of women with breast cancer to this issue," he says.

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