Two studies about postmastectomy breast reconstruction were recently published in JAMA Surgery. One study found overall complication rates of 32.9% at 2 years after reconstruction, with women having autologous reconstruction more likely to have complications than those having implant reconstruction.¹ The other study concluded: “At 2 years, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial well-being and sexual well-being than did those who underwent implant reconstruction.”²

The authors of both studies commented that their findings may assist physicians and their patients in making shared decisions about breast reconstruction. “But the results may not make the decision-making process easier for patients,” Deanna J. Attai, MD, Assistant Clinical Professor of Surgery at the David Geffen School of Medicine at the University of California, Los Angeles, and Past President of the American Society of Breast Surgeons, wrote in her blog³ following publication of the studies.

“Patients trying to make a decision about surgery have already been told they have cancer—that alone is enough to shake, even for the strongest of clear thinkers,” Dr. Attai wrote and was quoted in an article in The New York Times⁴ on the studies. “I have not figured out how to ensure that a patient is making a truly informed decision in this situation except through repeated discussion and questioning,” the blog continued.

How Much Information to Share and When

Just how much information about breast reconstruction and when physicians should impart it when patients are still trying to come to terms with a cancer diagnosis “depend on the situation.” In an interview with The ASCO Post, Dr. Attai said: “Some patients come in newly diagnosed, and we might need to do magnetic resonance imaging. We might need to do genetic testing. We are not even sure from the initial consultation if they are going to have a lumpectomy or mastectomy.”

For other patients, it may be “clear from the initial consultation—because they have already been diagnosed with the BRCA mutation or have cancer in multiple spots in the breast—we know right away that mastectomy is needed,” and the conversation about reconstruction options and potential complications will often begin then,” Dr. Attai said. “But in situations where we don’t know yet what we are going to do until we get additional testing, this kind of nuance often comes up at a second visit.”

In the blog and in an interview with The ASCO Post, Dr. Attai noted that the findings from the two studies should suggest to patients that reconstruction is a “process not a procedure, with the potential for short- and long-term complications.” ■

DISCLOSURE: Dr. Attai reported no conflicts of interest.

REFERENCES

1. Bennett KG, Qi J, Kim HM, et al: Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg. June 20, 2018 (early release online).

2. Santosa KB, Qi J, Kim HM, et al: Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. June 20, 2018 (early release online).

3. Attai DJ: Patient reported outcomes and complication rates from post-mastectomy reconstruction. Blog, June 24, 2018. Available at http://drattai.com/patient-reported-outcomes-and-complication-rates-from-post-mastectomy-reconstruction/. Accessed July 27, 2018.

4. Rabin RC: One in three women undergoing breast reconstruction have complications. The New York Times, June 20, 2018. Available at https://www.nytimes.com/2018/06/20/well/one-in-three-women-undergoing-breast-reconstruction-have-complications.html. Accessed July 27, 2018.