Increasing breast reconstruction rates by offering more women a choice

Abstract

Background: Breast reconstruction (BR) following mastectomy for breast cancer is safe and has high rates of patient satisfaction, yet only around 12% of Australian women undergo BR. This study presents BR rates and outcomes from a specialist practice that discusses reconstruction options with all women medically suitable for BR. Methods: Retrospective clinical study of all women that had undergone therapeutic mastectomy between 2009 and 2011. Patient, tumour and adjuvant therapy factors, and surgical complication rates, were compared between BR and no BR (NBR) patients. Results: Of the 331 women who had mastectomy for cancer, 136 (41%) had BR, with the vast majority (132, 97%) opting for immediate BR (IBR). Factors significantly associated with BR were young age, pure ductal carcinoma in-situ (DCIS), menopausal status and private health insurance. The main reasons for NBR were patient choice (88/195, 45%) and surgeon's perception of high-risk tumours (63/195, 32%). At mean follow-up of 15.6 months, five patients had developed local or distant recurrence (2 BR, 3 NBR). IBR did not cause significant delays in commencement of adjuvant therapy, and the BR group had a lower rate of surgical complications. Discussion: A BR rate of 41%, over three times the national average, was achieved when BR was discussed with all patients. This significant gain in BR rate was not accompanied by a commensurate increase in adverse outcomes, providing evidence that expanding the indications for BR to women who were previously not considered eligible is a valid option. © 2014 Royal Australasian College of Surgeons.