Expect and Encourage Questions About Breast Reconstruction



An article in The New York Times about women who had chosen not to have reconstruction following breast cancer surgery might prompt questions from newly diagnosed patients considering their options.1 Deanna J. Attai, MD, FACS, told The ASCO Post that whenever an article on breast cancer appears in a major publication like The New York Times, “it raises awareness among patients, and I think that is always a good thing. It might prompt a couple of questions that they hadn’t thought about. I don’t know if it will necessarily change their minds, but people might come in a little bit more educated than they were before.” Dr. ­Attai is Assistant Clinical Professor of Surgery at the David Geffen School of Medicine at the University of California, Los Angeles, and Immediate Past President of the American Society of Breast Surgeons.

In her online “Practice Philosophy” statement,2 Dr. Attai states that specializing in breast surgery “requires spending time getting to know the patient, understanding her disease, and then putting the two together to come up with a treatment plan that she is comfortable with.”

Appearance and Practical Concerns

Dr. Attai finds that most patients who have mastectomies are “at least initially” concerned to some degree about appearance and cosmetic results. “For patients who decide not to do reconstruction, that’s really low on their priority list,” Dr. Attai said. “There are very few women who will come in and say, ‘I don’t care what it looks like. I don’t care that I am flat.’”

Specializing in breast surgery requires spending time getting to know the patient, understanding her disease, and then putting the two together to come up with a treatment plan that she is comfortable with.
— Deanna J. Attai, MD, FACS

Practical concerns also need to be addressed, Dr. Attai said. These issues would include dressing for social occasions or, if the patient is athletic, wearing appropriate sportswear. For example, one of Dr. Attai’s patients said that one of her favorite pastimes was going to the pool with her young grandchildren. Dr. Attai reminded the patient to think about how the grandchildren would react to her in a swimsuit if she chose not to have reconstruction. “They are going to love you no matter what, but you just have to be aware of it,” she told the patient. Sometimes the discussion “is a little bit awkward,” Dr. Attai acknowledged, but it may prompt the patient to think about factors she might otherwise not have considered.

Very few women who are candidates for lumpectomy decide to have mastectomies just to have reconstruction. “I don’t see that too often,” Dr. Attai commented. “I think patients are well aware now that it is not just getting a new set of breasts. We have done a good job in educating our patients that reconstruction is not the same as cosmetic surgery.” Patients who could have lumpectomies may, however, choose to have mastectomy and reconstruction “to avoid radiation or out of fear of cancer remaining in the breast—all the reasons why mastectomy rates are increasing,” Dr. Attai said. ■

Disclosure: Dr. Attai reported no potential conflicts of interest.

References

1. Rabin RC: ‘Going flat’ after breast cancer. The New York Times, October 31, 2016.

2. Attai DJ: Practice philosophy. Available at http://drattai.com/practice-philosophy. Accessed November 9, 2016.


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