Would Plastic Surgeons Choose Breast Conservation Therapy?

• Published in: Annals of plastic surgery Vol. 82; no. 4S Suppl 3; pp. S202 - S207
• Main Authors: Myers, Paige L, Park, Rachel H, Mitchell, Drew C, Nghiem, Bao Tram, Amalfi, Ashley N
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-04-2019
• Subjects: Adult; Attitude of Health Personnel; Breast Neoplasms - surgery; Choice Behavior; Clinical Decision-Making; Female; Health Care Surveys; Humans; Male; Mastectomy, Segmental; Middle Aged; Surgeons - psychology; Surgeons - statistics & numerical data
• ISSN: 0148-7043; 1536-3708
• DOI: 10.1097/SAP.0000000000001922

BACKGROUNDBreast conservation therapy is defined as partial mastectomy with subsequent radiation therapy and is the treatment for early-stage breast cancer. However, the unwanted risks of radiation must be considered as well as the impact on future breast reconstruction options. The purpose of this study was to assess the preference of plastic surgeons when given the hypothetical diagnosis of breast cancer.
METHODSA survey assessing treatment preference of 3 hypothetical breast cancer diagnosis scenarios was designed and distributed by American Society of Plastic Surgeons via e-mail invite to its members.
RESULTSThe risk of cancer recurrence was the most common reason for treatment preferences of all three choices. However, for ductal carcinoma in situ, unilateral mastectomy with implant-based reconstruction is the preferred option with the second most influential reason of avoiding the risks of radiation therapy. For invasive ductal carcinoma node negative, unilateral mastectomy with implant-based reconstruction was the preferred option also due to risks of radiation therapy and anxiety of future surveillance. For invasive ductal carcinoma node positive, bilateral mastectomy with implant-based reconstruction was the preferred choice because of anxiety of future surveillance and also risks of radiation therapy.
CONCLUSIONSIn general, plastic surgeons did not prefer breast conservation therapy for in situ and early-stage breast cancer. Although the most common rationale for total mastectomy was risk of cancer recurrence for all disease severity, risks of radiation therapy are real and play an integral role in the decision-making process. In understanding our own biases, we can help better empathize with patients in consultation for breast reconstruction.