Addressing an Information Gap on Breast Reconstruction

By: Brittain Whiteside-Galloway
Friday, July 1, 2016

Breast reconstructive surgery candidates often are not well-informed about the procedure or the risk of complications, recent research suggests.

University of North Carolina Chapel Hill researchers assessed the level of knowledge about breast reconstructive surgery among patients planning to undergo mastectomies. A team led by Clara N. Lee, MD, MPP, then-Associate Professor at the UNC School of Medicine Division of Plastic and Reconstructive Surgery, surveyed nearly 130 patients. Published in Annals of Surgery, the study found that while the mean score of knowledge of the procedure was nearly 59 percent — and the majority of women were highly involved in decision-making — less than 15 percent of patients had knowledge regarding the risk for complications.

The findings raise concerns that at least some women who undergo breast reconstructive surgery might not have if they were more fully informed, says Dr. Lee, who has since become an Associate Professor at Ohio State University’s Department of Plastic Surgery and College of Public Health.

A Frank Discussion

Dr. Lee’s study found that while socioeconomic factors may have contributed to the lack of knowledge of potential risks, surgeons’ lack of emphasis on those considerations played a significant role: Far more patients reported discussing the advantages of breast reconstruction (57.9 percent) than the disadvantages (27.8 percent).

“I think it’s human nature for doctors and patients to talk about ... the benefits,” Dr. Lee says. “We have to remember to go a little bit against our human nature and openly discuss the cons as well.”

A conversation that involves potential negative outcomes can be difficult, she acknowledges, and she suggests practices such as using decision aids as well as enlisting not only surgeons but other providers in the medical office to help educate patients.

“As a surgeon who performs breast reconstructive surgeries, I live through the challenge of explaining all the complex information and making sure my patients understand. Mostly, it just takes a really long time. My own approach — and what I think is reasonable — is to take that time.”
— Clara N. Lee, MD, MPP, Associate Professor at Ohio State University’s Department of Plastic Surgery and College of Public Health

J. Brian Boyd, MD, Clinical Professor and Chief of the Division of Plastic & Reconstructive Surgery at Harbor-UCLA Medical Center, says he and his fellow surgeons deploy decision aids routinely and that spending time with patients detailing the procedure and answering questions is paramount.

“The American Society of Plastic Surgeons [produces] a booklet, which we distribute,” Dr. Boyd says. “We also refer patients to our website, which has before and after pictures, to give them an idea of what they’ll look like with each method of reconstruction. And I spend at least an hour with patients at their initial visit answering questions and explaining things. Sometimes they come in for two or three one-hour visits.”