PROVIDING THE OPTION OF BREAST RECONSTRUCTION: Giving Breast Cancer Patients the Choices They Need

This spring a new study on breast reconstruction following surgery for breast cancer made headlines in the national press. The study was originally reported in Cancer,* the prominent journal published on behalf of the American Cancer Society.

The results of this study indicated that there are systematic differences among general surgeons regarding referral to plastic surgeons prior to mastectomy for patients with breast cancer. It was concluded that women need more opportunities to discuss reconstructive options so that they may make informed surgical treatment decisions about their breast cancer.

The researchers who conducted the study surveyed 365 surgeons with 1,844 patients in Detroit and Los Angeles. They found that only 24% of surgeons referred more than three-quarters of their patients for plastic surgery, and 44% referred less than one-quarter.

Commenting on the study, Brian J. O'Hea, MD, associate professor of surgery and director of the Carol M. Baldwin Breast Care Center, says: "The vast majority of mastectomy patients are at least potential candidates for reconstruction. If the surgeon decides that a particular patient is not a candidate, then the reasons for that decision should be fully explained."

"All other mastectomy patients should be offered the opportunity to discuss reconstructive options with a plastic surgeon who is experienced in breast reconstruction. Some women are simply not interested in it, and their wishes need to be respected. All other women should be supported and encouraged to pursue reconstruction."

OUR MULTIDISCIPLINARY APPROACH BENEFITS OUR PATIENTS

At Stony Brook, our multidisciplinary team approach to breast cancer treatment distinguishes the quality of care we provide, and our breast surgeons work closely with plastic surgeons to give eligible patients the reconstructive options they need to consider for their treatment.

Our weekly Treatment Planning Conference is a multidisciplinary forum where we review potential treatment options for patients with newly diagnosed cancer or patients with recurrent disease. At this conference, their individual cases are presented to a team of highly trained cancer specialists, including radiologists, breast surgeons, pathologists, reconstructive surgeons, radiation oncologists, and medical oncologists.

Duc T. Bui, MD, assistant professor of surgery, is a reconstructive surgeon and active member of our multidisciplinary breast cancer team. He explains: "Breast reconstruction after mastectomy has an important role in the treatment of breast cancer. It can improve the psychosocial well-being and the quality of life of patients who have breast cancer."

"There are many options for breast reconstruction," Dr. Bui emphasizes. "It is important for patients to be referred to plastic surgeons to discuss what type of reconstruction is best for them as individuals. In addition, health insurance covers breast reconstructive procedures whether they are done immediately or later down the line."

When the surgeons in the Cancer study were asked why they did not refer women for breast reconstruction, almost half said the women were concerned about the cost, even though federal law mandates insurance coverage for breast reconstruction.

"Women should know that breast reconstruction is an option, and not just for wealthy women," explains Amy K. Alderman, MD, MPH, the lead author of the study, who was quoted by the New York Times. "Women should be able to talk to their healthcare provider about what those options are for them. And if their healthcare provider doesn't bring it up, then women should do so themselves."

At Stony Brook's Carol M. Baldwin Breast Care Center, breast cancer patients are given the choices they need about possible reconstruction following mastectomy.