Tuesday, September 27, 2005 - 11:10 AM

A Survey of Female Plastic Surgeons' Attitudes Toward Breast Reconstruction Options

Susan E. Downey, MD and Cheryl L Morales BSN.

Purpose: Breast cancer affects one in seven women. These patients then have to go through a maze of decisions as to whether they will opt for breast conservation usually with radiation therapy or will choose a mastectomy and then on to the various choices for reconstruction. Patients rely on plastic surgeons for guidance and may even ask the female plastic surgeon which option they would choose if they were the patient. Studies have been done of patient satisfaction regarding their method of reconstruction but no studies have been done as to physician preferences regarding type of reconstruction. Female plastic surgeons offer a unique look into the pros and cons of the different methods of beast reconstruction as due to their training they have knowledge of the types of procedures and due to their clinical experiences they have knowledge as to outcomes and consequences. This study was designed to explore the opinions of female plastic surgeons regarding breast reconstruction. Method: A questionnaire was developed for this study to inquire about female plastic surgeons preferences for treatment options if they were to be diagnosed with breast cancer. Demographic information was obtained as to age, years in practice, type of practice and country of practice. Results: At the 2003 ASPS meeting 54 female plastic surgeons attending the Women's Plastic Surgeons luncheon were polled by questionnaire as to the method of breast cancer treatment they would opt for if they were faced with the diagnosis of breast cancer. None of the female surgeons had been diagnosed with breast cancer. When asked as to what decision they would make if they were faced with the diagnosis of breast cancer and any option was available to them the responses were as follows. The overwhelming majority (49/54or 91%) stated that they would opt for mastectomy rather than undergo a lumpectomy and radiation. Most (47/54 or 87%) of female plastic surgeons choosing a mastectomy would opt for reconstruction. Only two (2/54) opted for mastectomy without reconstruction. For their reconstruction choices 29 female plastic surgeons (29/54 or 54%) would choose tissue expansion with implant and 15 (15/54 or 28%) would choose a tram flap. Only three (3/54 or 5%) would opt for a latissimus flap if all methods of reconstruction were available to them. For the women choosing implant reconstruction 23 (23/29 or 79%) would choose a silicone implant, 7 (7/29 or 24%) would choose a saline implant while one respondent felt either type of implant would be acceptable. The most frequently chosen reconstruction then was tissue expansion followed by a silicone implant (23/54 or 43%) Conclusion: Female plastic surgeons offer a unique insight into surgical outcomes following breast reconstruction. As plastic surgeons these physicians have a unique insight into the risks and benefits each technique offers. Ninety one percent of the female plastic surgeons stated that they would opt for mastectomy over breast conservation surgery. Although the Tram flap has long been considered the Gold Standard for breast reconstruction it is interesting that 54% of female plastic surgeons with their knowledge and experience with the various reconstructive methods used for breast reconstruction would choose a tissue expander reconstruction.
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