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The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment

Dobke, Marek K. MD, PhD*; Yee, Brittany MD*; Mackert, Gina A. MD; Zhu, William Y. BA*; Blair, Sarah L. MD

doi: 10.1097/SAP.0000000000001661
Breast Surgery: PDF Only
Open
PAP

Background The landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely.

Methods Plastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012–2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management.

Results In this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]).

Conclusions Decisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Division of Plastic Surgery, Department of Surgery, University of California San Diego, CA,

Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany; and

Division of Surgical Oncology, Department of Surgery, University of California San Diego, CA.

Received June 24, 2018, and accepted for publication, after revision August 20, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Marek K. Dobke, MD, PhD, Division of Plastic Surgery, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103. E-mail: mdobke@ucsd.edu.

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