A SURVEY OF GENERAL SURGEONS ATTITUDES TOWARDS BREAST RECONSTRUCTION AFTER MASTECTOMY

Within the last 15-20 years there have been many changes in the manage ment of breast cancer. Along with changes in treatment, possibilities for breast reconstruction have become increasingly sophisticated and c ommonplace. Despite the availability of breast reconstruction, we have noted large variations in referral patterns. Because the surgical tre atment 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 hypothetica l criticisms was sent to general surgical members of the Association o f Surgeons of Great Britain and Ireland. A total of 136 surgeons respo nded, 79 (58%) of whom had a specialist interest in breast cancer. Eac h surgeon saw an average of 68 new cases of breast cancer per year (ra nge 0-400). The general surgeons were concerned about three areas: (1) 32.3% felt that breast reconstruction might adversely delay the detec tion of local recurrence; (2) 16.6% were worried that breast reconstru ction has high morbidity; and (3) 17.4% said that patients did not wan t breast reconstruction despite being advised of its availability. To investigate these concerns further, an extensive literature search was undertaken. There is no evidence that breast reconstruction delays th e detection of local recurrence. With appropriate patient selection, t he morbidity of reconstructive options appears very acceptable. Finall y, immediate breast reconstruction has psychological benefits when com pared with delayed reconstruction.