Skip to main content
NCBI home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1998 May;80(3):178–183.

A survey of general surgeons' attitudes towards breast reconstruction after mastectomy.

G E Spyrou 1, O G Titley 1, J Cerqueiro 1, M F Fatah 1
PMCID: PMC2503029  PMID: 9682639

Abstract

Within the last 15-20 years there have been many changes in the management of breast cancer. Along with changes in treatment, possibilities for breast reconstruction have become increasingly sophisticated and commonplace. Despite the availability of breast reconstruction, we have noted large variations in referral patterns. Because the surgical treatment of breast cancer is largely undertaken by general surgeons, we investigated general surgeons' attitudes towards reconstruction using a postal questionnaire. In 1995, a questionnaire involving hypothetical criticisms was sent to general surgical members of the Association of Surgeons of Great Britain and Ireland. A total of 136 surgeons responded, 79 (58%) of whom had a specialist interest in breast cancer. Each surgeon saw an average of 68 new cases of breast cancer per year (range 0-400). The general surgeons were concerned about three areas: (1) 32.3% felt that breast reconstruction might adversely delay the detection of local recurrence; (2) 16.6% were worried that breast reconstruction has high morbidity; and (3) 17.4% said that patients did not want breast reconstruction despite being advised of its availability. To investigate these concern's further, an extensive literature search was undertaken. There is no evidence that breast reconstruction delays the detection of local recurrence. With appropriate patient selection, the morbidity of reconstructive options appears very acceptable. Finally, immediate breast reconstruction has psychological benefits when compared with delayed reconstruction.

Full text

PDF
178

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beasley M. E. The pedicled TRAM as preference for immediate autogenous tissue breast reconstruction. Clin Plast Surg. 1994 Apr;21(2):191–205. [PubMed] [Google Scholar]
  2. Becker H. Breast reconstruction using an inflatable breast implant with detachable reservoir. Plast Reconstr Surg. 1984 Apr;73(4):678–683. doi: 10.1097/00006534-198404000-00031. [DOI] [PubMed] [Google Scholar]
  3. Becker H., Maraist F. Immediate breast reconstruction after mastectomy using a permanent tissue expander. South Med J. 1987 Feb;80(2):154–160. doi: 10.1097/00007611-198702000-00004. [DOI] [PubMed] [Google Scholar]
  4. Bostwick J., 3rd, Nahai F., Wallace J. G., Vasconez L. O. Sixty latissimus dorsi flaps. Plast Reconstr Surg. 1979 Jan;63(1):31–41. doi: 10.1097/00006534-197901000-00006. [DOI] [PubMed] [Google Scholar]
  5. Burk R. W., 3rd, Grotting J. C. Conceptual considerations in breast reconstruction. Clin Plast Surg. 1995 Jan;22(1):141–152. [PubMed] [Google Scholar]
  6. Camilleri I. G., Malata C. M., Stavrianos S., McLean N. R. A review of 120 Becker permanent tissue expanders in reconstruction of the breast. Br J Plast Surg. 1996 Sep;49(6):346–351. doi: 10.1016/s0007-1226(96)90001-6. [DOI] [PubMed] [Google Scholar]
  7. Crespo L. D., Eberlein T. J., O'Connor N., Hergrueter C. A., Pribaz J. J., Eriksson E. Postmastectomy complications in breast reconstruction. Ann Plast Surg. 1994 May;32(5):452–456. doi: 10.1097/00000637-199405000-00002. [DOI] [PubMed] [Google Scholar]
  8. De Mey A., Lejour M., Declety A., Meythiaz A. M. Late results and current indications of latissimus dorsi breast reconstructions. Br J Plast Surg. 1991 Jan;44(1):1–4. doi: 10.1016/0007-1226(91)90167-i. [DOI] [PubMed] [Google Scholar]
  9. Dean C., Chetty U., Forrest A. P. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983 Feb 26;1(8322):459–462. doi: 10.1016/s0140-6736(83)91452-6. [DOI] [PubMed] [Google Scholar]
  10. Dean C. The emotional impact of mastectomy. Br J Hosp Med. 1988 Jan;39(1):30-2, 36, 38-9. [PubMed] [Google Scholar]
  11. Elliott L. F., Eskenazi L., Beegle P. H., Jr, Podres P. E., Drazan L. Immediate TRAM flap breast reconstruction: 128 consecutive cases. Plast Reconstr Surg. 1993 Aug;92(2):217–227. doi: 10.1097/00006534-199308000-00004. [DOI] [PubMed] [Google Scholar]
  12. Feller A. M. Free TRAM. Results and abdominal wall function. Clin Plast Surg. 1994 Apr;21(2):223–232. [PubMed] [Google Scholar]
  13. Fisher B., Bauer M., Margolese R., Poisson R., Pilch Y., Redmond C., Fisher E., Wolmark N., Deutsch M., Montague E. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985 Mar 14;312(11):665–673. doi: 10.1056/NEJM198503143121101. [DOI] [PubMed] [Google Scholar]
  14. Georgiade G., Georgiade N., McCarty K. S., Jr, Seigler H. F. Rationale for immediate reconstruction of the breast following modified radical mastectomy. Ann Plast Surg. 1982 Jan;8(1):20–28. doi: 10.1097/00000637-198201000-00006. [DOI] [PubMed] [Google Scholar]
  15. Grotting J. C., Urist M. M., Maddox W. A., Vasconez L. O. Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg. 1989 May;83(5):828–844. doi: 10.1097/00006534-198905000-00009. [DOI] [PubMed] [Google Scholar]
  16. Johnson C. H., van Heerden J. A., Donohue J. H., Martin J. K., Jr, Jackson I. T., Ilstrup D. M. Oncological aspects of immediate breast reconstruction following mastectomy for malignancy. Arch Surg. 1989 Jul;124(7):819–824. doi: 10.1001/archsurg.1989.01410070073015. [DOI] [PubMed] [Google Scholar]
  17. Kroll S. S., Baldwin B. A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg. 1992 Sep;90(3):455–462. doi: 10.1097/00006534-199209000-00015. [DOI] [PubMed] [Google Scholar]
  18. Maguire P. The psychological consequences of the surgical treatment of cancer of the breast. Surg Annu. 1990;22:77–91. [PubMed] [Google Scholar]
  19. Mendelson B. C. A survey of general surgeon's attitudes towards breast reconstruction following mastectomy. Aust N Z J Surg. 1981 Aug;51(4):348–350. doi: 10.1111/j.1445-2197.1981.tb04962.x. [DOI] [PubMed] [Google Scholar]
  20. Noda S., Eberlein T. J., Eriksson E. Breast reconstruction. Cancer. 1994 Jul 1;74(1 Suppl):376–380. doi: 10.1002/cncr.2820741325. [DOI] [PubMed] [Google Scholar]
  21. Noone R. B., Murphy J. B., Spear S. L., Little J. W., 3rd A 6-year experience with immediate reconstruction after mastectomy for cancer. Plast Reconstr Surg. 1985 Aug;76(2):258–269. doi: 10.1097/00006534-198508000-00012. [DOI] [PubMed] [Google Scholar]
  22. Petit J. Y., Lê M. G., Mouriesse H., Rietjens M., Gill P., Contesso G., Lehmann A. Can breast reconstruction with gel-filled silicone implants increase the risk of death and second primary cancer in patients treated by mastectomy for breast cancer? Plast Reconstr Surg. 1994 Jul;94(1):115–119. doi: 10.1097/00006534-199407000-00011. [DOI] [PubMed] [Google Scholar]
  23. RENNEKER R., CUTLER M. Psychological problems of adjustment to cancer of the breast. J Am Med Assoc. 1952 Mar 8;148(10):833–838. doi: 10.1001/jama.1952.02930100051011. [DOI] [PubMed] [Google Scholar]
  24. Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg. 1982 Feb;69(2):195–208. doi: 10.1097/00006534-198202000-00001. [DOI] [PubMed] [Google Scholar]
  25. Reaby L. L., Hort L. K. Postmastectomy attitudes in women who wear external breast prostheses compared to those who have undergone breast reconstructions. J Behav Med. 1995 Feb;18(1):55–67. doi: 10.1007/BF01857705. [DOI] [PubMed] [Google Scholar]
  26. Reaby L. L., Hort L. K., Vandervord J. Body image, self-concept, and self-esteem in women who had a mastectomy and either wore an external breast prosthesis or had breast reconstruction and women who had not experienced mastectomy. Health Care Women Int. 1994 Sep-Oct;15(5):361–375. doi: 10.1080/07399339409516129. [DOI] [PubMed] [Google Scholar]
  27. Titley O. G., Spyrou G. E., Fatah M. F. Preventing seroma in the latissimus dorsi flap donor site. Br J Plast Surg. 1997 Feb;50(2):106–108. doi: 10.1016/s0007-1226(97)91321-7. [DOI] [PubMed] [Google Scholar]
  28. Veronesi U., Saccozzi R., Del Vecchio M., Banfi A., Clemente C., De Lena M., Gallus G., Greco M., Luini A., Marubini E. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981 Jul 2;305(1):6–11. doi: 10.1056/NEJM198107023050102. [DOI] [PubMed] [Google Scholar]
  29. Vinton A. L., Traverso L. W., Zehring R. D. Immediate breast reconstruction following mastectomy is as safe as mastectomy alone. Arch Surg. 1990 Oct;125(10):1303–1308. doi: 10.1001/archsurg.1990.01410220087012. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES