Patients Lack Knowledge of Breast Reconstruction Before Surgery

Clara Lee, MD, MPP

Clara Lee, MD, MPP

Breast reconstruction surgery has become an increasingly popular option among women following mastectomy, but a recent study has found that most women who opt for the procedure are ill-informed of the potential risks.

“The decision about breast reconstruction is a type of medical decision that we call ‘preference sensitive,’ in that the best or right choice depends mostly on patient preference,” lead author Clara Lee, MD, MPP, member, UNC Lineberger, associate professor, UNC School of Medicine Division of Plastic and Reconstructive Surgery, said in a statement.

“For these types of decisions, whether or not it was a good decision is whether or not the decision was informed, and whether or not the treatment matches what the patient prefers.”

In a prospective, cross-sectional study, investigators surveyed 126 patients who were planning to undergo a mastectomy and evaluated them over 20 months to assess their knowledge about breast reconstruction and their involvement in the decision-making process. They were asked general knowledge questions about the surgery as well as questions about complication risks.

The study, published in Annals of Surgery, found patient knowledge about the risk of complications associated with breast reconstruction was especially low, with only 14.3% of patients answering questions about major complications correctly. A majority of the patients (70%) knew at least half of the important facts about breast reconstruction, but the average knowledge score among participants was 58.5%, which researchers classified as moderate knowledge.

“By that metric, patients did OK,” Lee said. “But I do think that’s a pretty low bar for surgery that’s purely optional.” The rates of women electing to undergo breast reconstruction after mastectomy have risen more than 24 percentage points to 36.4% in 2011 in patients with early-stage breast cancer.

Complications from breast reconstruction surgery—some of which can delay cancer treatment—can include difficulty healing, infection, swelling, fluid under the wound, and flap or implant complications.

The participants in the study were highly involved with their physicians in the decision-making process, but deficits in knowledge persisted.

Of the 126 women, 92% reported discussing the procedure with their providers, and 90.4% were asked their preference.

However, the findings suggest that providers emphasize advantages over disadvantages in their discussions as nearly 60% of patients reported hearing about the pros while only about 28% discussed the cons of breast reconstruction.

“Our general conclusion after this study is not that breast reconstruction is good or bad, but that patients don’t fully understand it, and we need ways to improve that,” Lee said.

The authors concluded that interventions are needed to help women navigate through the decision-making process. “I really care about making the lives of cancer patients better,” Lee said.

“I think a critical part of that is helping them to make good choices. And the other motivation for me is that I have a very strong passion for fairness in surgery and in medicine. People who value treatment should get it, and people who don’t actually want it, or really are worried about complications for elective procedures, shouldn’t have it.”

Lee CN, Ubel PA, Deal, AM, et al. How informed is the decision about breast reconstruction after mastectomy?: A prospective, cross-sectional study [published ahead of print December 31, 2015]. Ann Surg.