title: Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer.
abstract: BACKGROUND
  Reconstruction is rarely incorporated into the decision-making process for surgical breast cancer treatment. We examined the importance of knowing about reconstruction to patients' surgical decision-making for breast cancer.
  
  
  METHODS
  We surveyed women aged < or =79 years with breast cancer (N = 1844) who were reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) cancer registries (response rate, 77.4%). The dependent variables were 1) patients' report of having a discussion about breast reconstruction with their general surgeon (yes/no), 2) whether or not this discussion had an impact on their willingness to be treated with a mastectomy (yes/no), and 3) whether the patient received a mastectomy (yes/no). The independent variables included age, race, education, tumor size, tumor behavior, and presence of comorbidities. Chi-square, Student t test, and logistic regression were used for analyses.
  
  
  RESULTS
  Only 33% of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients with larger tumors. Knowing about reconstructive options significantly increased patients' willingness to consider a mastectomy (OR, 2.06; P <.01). In addition, this discussion influenced surgical treatment. Patients who discussed reconstruction with their general surgeon were 4 times more likely to receive a mastectomy compared with those who did not (OR, 4.48; P < .01).
  
  
  CONCLUSIONS
  Most general surgeons do not discuss reconstruction with their breast cancer patients before surgical treatment. When it occurs, this discussion significantly impacts women's treatment choice, making many more likely to choose mastectomy. This highlights the importance of multidisciplinary care models to facilitate an informed surgical treatment decision-making process.
authors.affiliation: Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0340, USA. aalder@umich.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Waljee
authors.forename: Mahasin
authors.initials: M
authors.lastname: Mujahid
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D002140:California; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty; D008408:Mastectomy; D008824:Michigan; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D018426:SEER Program