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Few M.D.s talk of breast reconstruction

Most doctors don't talk about breast reconstruction with women before cancer surgery, depriving them of key information that can sway their decision about whether to have the whole breast or just a lump removed, new research suggests.

Only one-third of the roughly 1,200 women in the study said surgeons discussed cosmetic remedies with them in advance. When the topic did come up, women were four times more likely to choose the more drastic operation, mastectomy.

That could be because they liked the breast reconstruction options, which include implants not available for fixing odd-shaped defects left after lumpectomies. But mastectomies can be a dubious choice because breast-conserving lumpectomies usually suffice.

"Our point is not to say that one decision is better than another, but that women need to know all their options," said Dr. Amy Alderman, the University of Michigan plastic surgeon who led the study. "There are positives and negatives to both. We shouldn't be paternalistic and tell patients, 'This is what you need.'"

It is the second recent report to call attention to the often-neglected cosmetic consequences of cancer surgery. Studies at last week's San Antonio Breast Cancer Symposium highlighted some of these, including the limited options for millions left with dimpled or cratered breasts after lumpectomies.

Researchers surveyed 1,178 women three months after breast cancer surgery, from 2001 to 2003. Two-thirds said reconstruction never came up in discussions with general surgeons before their operations.

Younger women were more likely to have had this talk than older ones (the average age was 56 for those who did versus 61 for those who did not). More educated women also were more likely to discuss it. Who brought up the topic - patient or doctor - was not asked.

[Last modified December 21, 2007, 01:20:46]