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Some women not told about breast reconstruction

What breastcancer.org says about this article

Breast reconstruction during or after surgery to remove breast cancer (mastectomy or lumpectomy) is an important option that ALL women should discuss with their doctors.

The study reviewed here found that doctors may not discuss breast reconstruction options with a woman before she has a mastectomy, especially if the woman is older, Hispanic, or less educated. Younger, more educated, or white women are more likely to be told about reconstruction. Other research has shown that many women aren't referred to a plastic surgeon to discuss reconstruction options, even after mastectomy.

Not all women want breast reconstruction after surgery to remove breast cancer. Reconstruction is a personal choice and you need to decide what's best for your situation. In the United States, about 75% of women who have mastectomy also have one or both breasts reconstructed. In many but not all cases, breast reconstruction can be done at the same time as mastectomy or lumpectomy. So it's important that ALL women, no matter their age, race, or education, talk to their doctors about breast reconstruction BEFORE surgery to remove breast cancer.

If you've already had a mastectomy or lumpectomy and you and your doctor didn't discuss reconstruction beforehand, you can still talk to your doctor about breast reconstruction. You may decide not to have reconstruction, but it can be helpful to consider all your options. If your surgeon doesn't bring up reconstruction, ask for more information and a referral.

Here are some questions you might want to consider as you're making your decision about breast reconstruction:

  • Is it important to you to have a permanent breast shape? Some women prefer to wear a prosthesis instead of having reconstruction.
  • Is it important to you that your breasts to look balanced when wearing a bra and bathing suits? Though you'll be able to see the difference between the rebuilt breast and your other breast when you're naked, reconstruction usually looks very natural when you're wearing a bra or bathing suit.
  • In your unique situation, will breast reconstruction involve several surgeries over a long period of time? For many women, the answer is yes.
  • Will your insurance pay for all the reconstruction procedures? Find out what your insurance company will cover.
  • Did you have a lumpectomy that gave your breast a very different shape than it originally had? If you had a large portion of tissue removed, you might want to have reconstruction to restore a more balanced look.
  • Do you have any other medical conditions that might affect your ability to heal after surgery? If you have diabetes, circulatory problems, or a bleeding disorder, it may take your body longer to heal from reconstruction surgery than someone who doesn't have these conditions.
  • Do you have a condition that might give you a distorted image of your body? If you've been diagnosed with anorexia or bulimia, you may have a hard time accepting how your body looks in general, which may make it hard to accept how your reconstructed breast looks.

For more information, including types of reconstruction and the timing of reconstruction, visit the breastcancer.org Reconstruction section.

Last Updated: 2008-05-01 16:24:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Doctors don't universally discuss the option of breast reconstruction with all women undergoing mastectomy, results of a new study confirm.

Doctors are most apt to have these conversations with younger, more educated white women, than with older, less educated, Hispanic women, Dr. Caprice C. Greenberg, from Brigham and Women's Hospital, Boston, and colleagues found. Prior studies have shown that women who are not privy to these conversations are less likely to undergo breast reconstruction.

"Women need to know all the facts about breast reconstruction," Greenberg noted in a telephone interview with Reuters Health, "and if your physician doesn't bring it up, women should be proactive and not afraid to ask if reconstruction is an option if they do need a mastectomy."

Greenberg also noted that in the majority of instances, breast reconstruction is performed at the same time as mastectomy. "It's all done in one procedure, so it is absolutely important to discuss it before hand."

In a review of 626 women with breast cancer who underwent mastectomy, Greenberg and colleagues found that 253 (40.4 percent) also had breast reconstruction. In 249 women (39.8 percent), the medical records documented that the doctor discussed breast reconstruction with the patient.

Roughly 70 percent of women who had a discussion about breast reconstruction with their doctor opted for reconstruction. As mentioned, younger, more educated, Caucasian women who were not overweight or receiving radiation therapy after mastectomy were more likely than other women to have breast reconstruction and more likely to have had a conversation about it with their doctor.

The researchers also found that breast reconstruction was less likely if the patient was older, Hispanic or born outside the US, even if they had had a conversation with their doctor about post-mastectomy breast reconstruction.

"Although decisions about reconstruction after mastectomy should rest primarily on clinical considerations," this study, like others, has shown variation in the likelihood of reconstruction according to age, education, and race, Greenberg and colleagues note in the Journal of the American College of Surgeons.

"Breast reconstruction is purely an elective procedure and it's not for everybody," Greenberg said. "Doctors have to take clinical factors into account; your physician may say you are not a candidate for immediate reconstruction but that discussion should happen with everybody."

SOURCE: Journal of the American College of Surgeons, April 2008.

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This page was last modified on: May 5, 2008

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