Surgeon Gender Affects Patient-Reported Satisfaction after Breast Reconstruction

PURPOSE

Previous investigators have demonstrated that female patients often prefer female providers¹. While there are limited studies evaluating the role of gender in women’s choices of  breast oncology surgeons^2,3, previous reports have not assessed the effects of surgeon gender on patient satisfaction and other patient-reported outcomes (PROs) in breast reconstruction. Using a multicenter, prospective design, the current study sought to analyze the impact of surgeon gender on PROs in women undergoing post-mastectomy reconstruction. 

METHODS

Patients were recruited as part of the prospective, multicenter Mastectomy Reconstruction Outcomes Consortium (MROC), a National Institute of Health-funded study (R01 CA152192). Surgeon gender, reconstructive procedure type, timing of reconstruction, lymph node management, and receipt of radiation or chemotherapy were collected for all patients. Patient reported outcomes, including satisfaction with surgeon, satisfaction with information provided, and satisfaction with overall outcome, were assessed using the BREAST-Q questionnaire at three months and two years following breast reconstruction. Univariate and multivariable logistic regression analyses were performed to investigate the effects of surgeon gender on PROs. 

RESULTS

A total of 2,236 patients from the practices of 55 male breast reconstruction surgeons and 9 female surgeons were included in the analysis. In this cohort, 1921 (82.2%) patients had male surgeons whereas 415 (17.8%) patients had a female surgeon. There were no significant differences in sociodemographic variables between the patients in the male-surgeon and female-surgeon groups. There were also no differences in receipt of radiation or chemotherapy.

On univariate analysis, female surgeons were more likely to perform immediate reconstruction (95.7% vs. 89.9%, p<0.001) and implant-based breast reconstruction (78.8% vs. 62.9%, p<0.001), compared to male surgeons.  Patients with female surgeons reported greater satisfaction with their surgeon (p<0.001) and information received (p<0.05) at three months after breast reconstruction. Similarly, patients in the female-surgeon group reported statistically significantly greater satisfaction with overall outcome (p<0.05) at two years following breast reconstruction.

Multivariate analysis of two-year postoperative PROs revealed patients with a female surgeon experienced significantly greater satisfaction with their surgeon (adjusted mean difference=4.45, p<0.0001) and higher satisfaction with information received (adjusted mean difference=2.74, p<0.01), compared to patients in the male-surgeon group. Patients in the female-surgeon group also reported greater satisfaction with overall breast reconstruction outcome (adjusted mean difference=2.91), though this finding only approached statistical significance (p=0.059).

CONCLUSIONS

Based on our findings, surgeon gender appears to be one of the many factors influencing PROs in breast reconstruction. However, more investigation is necessary to determine why this may be the case: Do patients’ expectations simply vary depending on provider gender, or are these differences in outcomes attributable to variations in practices between male and female surgeons?  

 

 

1. Kerssens JJ, Bensing JM, Andela MG. Patient preference for genders of health professionals. Soc Sci Med. 1997;44(10):1531-1540.
2. Reid I. Patients' preference for male or female breast surgeons: questionnaire study. BMJ. 1998;317(7165):1051-1060. doi:10.1136/bmj.317.7165.1051.
3. Groutz A, Amir H, Caspi R, Sharon E, Levy YA, Shimonov M. Do women prefer a female breast surgeon? Isr J Health Policy Res. 2016;5(1):259. doi:10.1186/s13584-016-0094-3.