Surgeon motivations behind the timing of breast reconstruction in patients requiring postmastectomy radiation therapy.
OBJECTIVE
Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT.


METHODS
Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were analyzed using standard descriptive statistics.


RESULTS
A total of 330 members of the ASPS and 348 members of the ASBS and SSO participated in our survey. PRS and SO differed in patient-payor mix (p < 0.01) and practice setting (p < 0.01), but they did not differ by urban versus rural setting (p = 0.65) or geographic location (p = 0.30). Although PRS favored immediate reconstruction versus SO, overall timing did not significantly differ between the two specialists (p = 0.14). The primary rationale behind delayed breast reconstruction differed significantly between PRS and SO (p < 0.01), with more PRS believing that the reconstructive outcome is significantly and adversely affected by radiation. Both PRS and SO cited "patient-driven desire to have immediate reconstruction" (p = 0.86) as the primary motivation for immediate reconstruction.


CONCLUSIONS
Although the optimal timing of reconstruction is controversial between PRS and SO, our study suggests that the timing of reconstruction in PMRT patients is ultimately driven by patient preferences and the desire of PRS to optimize aesthetic outcomes.
Emory University School of Medicine, Atlanta, GA, USA.
Ming
M
Lee
Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Erik
E
Reinertsen
Emory University School of Medicine, Atlanta, GA, USA; Goizueta Business School, Emory University, Atlanta, GA, USA.
Evan
E
McClure
Department of Biostatistics, Rollins School of Public Health at Emory University, Atlanta, GA, USA.
Shuling
S
Liu
Division of Surgical Oncology, City of Hope Cancer Center, Los Angeles, CA, USA.
Laura
L
Kruper
Division of Plastic and Reconstructive Surgery, North Shore - LIJ Health System, New York, NY, USA.
Neil
N
Tanna
Harbor-UCLA Medical Center and the UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
J
J
Brian Boyd
Harbor-UCLA Medical Center and the UCLA David Geffen School of Medicine, Los Angeles, CA, USA. Electronic address: DrJay@PlasticSurgery.LA.
Jay W
JW
Granzow
D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008495:Medical Oncology; D009042:Motivation; D011182:Postoperative Care / Q000379:methods* / Q000523:psychology; D018714:Radiotherapy, Adjuvant; D012955:Societies, Medical; D066231:Surgeons / Q000523:psychology*; D013518:Surgery, Plastic; D013997:Time Factors
Breast reconstruction; Current practices; Delayed breast reconstruction; Delayed–immediate breast reconstruction; Immediate breast reconstruction; Postmastectomy radiation therapy