Published January 21, 2016
Women deciding whether to get breast reconstruction after a mastectomy may not have all the facts needed to make an informed decision, a small U.S. study suggests.
Researchers analyzed survey responses from 126 women undergoing mastectomies and found most of them reported discussing reconstruction with their doctors, but only 58 percent recalled specific conversations about the benefits of this option and just 28 percent remembered talking about the risks.
"If patients don't fully understand their options, they may make a choice that is not truly what they will be happy with," said lead study author Dr. Clara Nan-hi Lee of the University of North Carolina (UNC) Chapel Hill.
The main risks women should consider are complications such as delayed healing or infections, the potential for repeat surgery and the longer recovery period, Lee said by email. The biggest benefits can be improved satisfaction with post-mastectomy body image and eliminating the need to wear a prosthesis, Lee added.
Most women with breast cancer have some type of surgery - either a lumpectomy that removes malignant tissue while sparing the rest of the breast or a mastectomy that removes the entire breast. After surgery, many of them also receive chemotherapy to destroy any remaining abnormal cells and reduce the risk of cancer coming back.
Many women who get a mastectomy don't immediately get breast reconstruction, however, sometimes due to a mistaken belief that this might delay detection of cancer recurrence in the future.
To assess how well women understood the pros and cons of reconstruction, Lee and colleagues reviewed survey data from women who had mastectomies at the North Carolina Cancer Hospital, which is affiliated with UNC.
The women answered multiple-choice questions about their knowledge of reconstruction. Overall, the average score on the questions was about 59 percent.
Seven out of 10 women provided correct responses to at least half the questions.
Knowledge was much worse, however, when it came to the risks of reconstruction. Just 14 percent of participants knew that the risk of major complications within the first two years after surgery was 16 to 40 percent. Most of the time, women underestimated the risk.
In addition, just four in 10 participants knew that women tend to be equally satisfied after a mastectomy whether or not they get reconstruction.
Just six in 10 women knew that reconstruction doesn't affect cancer detection in future screenings.
And, while reconstruction doesn't influence the odds of cancer returning, only three quarters of women correctly provided this response.
Limitations of the study include its reliance on participants from a single clinic, as well as a population of women who may be better educated and wealthier than a typical breast cancer patient, the authors note in the Annals of Surgery.
While more research is needed to better understand how well women comprehend their options after a mastectomy, the findings suggest that women may not be getting all the facts they need to make an informed decision, the authors conclude.
The choice about reconstruction may be a largely personal one, but some characteristics can also make patients better or worse candidates for this option, said Dr. Lisa Schneider, a surgeon at the Institute for Advanced Reconstruction at The Plastic Surgery Center in Shrewsbury, New Jersey.
Women who are younger with a normal body weight and no major medical problems other than cancer may be better candidates for reconstruction, Schneider, who wasn't involved in the study, said by email.
Patients who are elderly or obese, smokers, or who have health problems such as diabetes or bleeding disorders might not be good candidates for surgery, Schneider said. Some women with very aggressive or advanced tumors might also want to get additional chemotherapy or radiation prior to breast reconstruction.