Breast Cancer Surgeons Don't Discuss Reconstruction Options

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The operation to reconstruct a breast can be done right after mastectomy, in which the entire breast is removed, or it can be delayed. Immediate reconstruction offers a better cosmetic outcome and is psychologically better, Alderman said.

"It's helpful if they know all their options at that initial decision-making process," Alderman said. "There's no right or wrong answer."

Women will choose their course, she said, based on a number of factors, including their fear of cancer recurrence, their body image, and other factors.

"What we need to get across to consumers is, they need to be educated consumers of their own health care," Alderman said. If the surgeon doesn't bring up the topic of reconstruction, a woman should, she said, and the sooner the better.

The study didn't delve into why the surgeons didn't talk about the reconstruction option or refer the women to plastic surgeons. But Alderman suspected the "hassle" factor may play a role. The general surgeon must make sure, she said, that the women get in to see the surgeon who will do the reconstruction in a timely manner. "And then the general surgeon and the plastic surgeon have to coordinate their operating room schedules," she said.

Women themselves may be so focused on eliminating the cancer that they don't even broach the topic of reconstruction, Alderman said.

Another expert agreed that the small number of surgeons who initially discussed the reconstruction option was surprising.

"It's very sad that that so few surgeons are sending women for reconstructive appointments," said Dr. Mehra Golshan, director of Breast Surgical Services at the Dana-Farber/Brigham and Women's Cancer Center, Boston, who reviewed the study.

An initial meeting with a surgeon who does reconstruction will provide a woman with information on all options, "even if they decide to do [reconstruction] down the road," he said.

Like Alderman, Golshan couldn't say for sure why such a low number of surgeons referred their breast cancer patients to plastic surgeons for reconstruction discussions, but he speculated on a few possible reasons. "They may think complication rates are too high with immediate reconstruction," he said.