PREFERENCES IN CHOOSING BETWEEN BREAST RECONSTRUCTION OPTIONS: A SURVEY OF FEMALE PLASTIC SURGEONS
Hani Sbitany, MD, Ashley N. Amalfi, BA, Howard N. Langstein, MD.
University of Rochester, Rochester, NY, USA.
Purpose: A woman’s decision to reconstruct her breast following mastectomy is a difficult and personal one, best made with full and accurate knowledge of the options. Perhaps no group of women is better informed to make this choice than female Plastic Surgeons, based on their knowledge of the actual procedures and first hand experience with results. To this end, we surveyed this group, to elicit their personal views on various modalities of breast reconstruction, and to ascertain which types of reconstruction they would choose if faced with such a decision.
Methods: All board-certified female plastic surgeons in the United States and Canada were surveyed via electronic mail. This survey included questions regarding demographic data, BMI and breast size, physical activity, and frequency and types of breast reconstruction practiced. In addition, respondents were requested to rank desired methods of reconstruction for themselves, and their reasons for these choices.
Results: A total of 435 surveys were sent, and 143 were returned (response rate of 33%). Overall, 66% of respondents chose implant-based reconstruction, 25% chose autologous reconstruction, and 9% chose no reconstruction. Results stratified by type of breast reconstruction practiced indicated that among the 43 surgeons performing large amounts of implant-based reconstruction, 76% (33) opted for implant reconstruction, 12% (5) chose autologous reconstruction, and 12% (5) chose no reconstruction. Surgeons performing large volumes of autologous reconstruction (6) were split, with 50% each choosing implant versus autologous reconstruction. Of those 63 respondents performing small amounts of breast reconstruction annually (less than 30 procedures of any type), 62% (39) opted for implant reconstruction, 32% (20) chose autologous breast reconstruction, and 6% (4) chose no reconstruction. Among the 21 surgeons performing no breast reconstruction in their practice, 57% (12) elected to personally proceed with implant reconstruction, while 29% (6) indicated a desire for autologous reconstruction, and 14% (3) opted for no reconstruction. When analyzing the reasons for choosing different techniques, respondents selecting autologous reconstruction cited cosmetic outcome as the most important factor considered in 47% of cases, compared with 14% of those choosing implant-based breast reconstruction (p=.004). In addition, invasiveness of the procedure had a significant effect on choice of breast reconstruction, and was cited as most important factor considered by 58% of those surgeons opting for no breast reconstruction, 27% of those choosing implant-based breast reconstruction, and none of those opting for autologous breast reconstruction (p=.003).
Conclusions: Board-certified female plastic surgeons exhibit a strong desire to pursue implant-based breast reconstruction over autologous reconstruction, when choosing for themselves, even when they perform primarily autologous reconstruction. The most significant reason for choosing implant-based reconstruction was its less invasive nature. When chosen, autologous reconstruction was felt to offer improved aesthetic outcomes. The nature of the surgeons’ practices had no statistically significant bearing on their personal choice for reconstruction. Several factors influence women’s choices for reconstruction. When choosing, patients should ask their female Plastic Surgeons which option they would choose for themselves, to make the most informed decision.