Ishak, Ariffuddin
(2018)
Breast reconstruction after mastectomy : a survey of surgeons' and patients' perception.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Breast reconstruction post-mastectomy is important in breast cancer care.
Methodology
A cross-sectional study was designed to assess surgeons’ and patients’ perceptions
towards breast reconstruction. Questionnaires were distributed to all general and breast
surgeons in East Coast Malaysia’s general and teaching hospitals and Hospital Kuala
Lumpur (n=40), post-mastectomy patients with (n=66) and without breast reconstruction
(n=291) from Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan
Zainab II (HRPZ II). Response rates were 82.5% surgeons (n=33), 95.4% patients with
reconstruction (n=63) and 95.5% patients without reconstruction (n=278).
Result
Data from 30 surgeons (3 excluded as 1 surgeon no longer treating breast diseases
and 2 incomplete responses) showed median age of 42 years with 6 years’ experience. Each
surgeon saw average 20 new breast cancer cases a year. Most surgeons (86.7%) discussed
reconstruction option with patients. However, referral rate was low whereby each surgeon
referred only average 4 cases for reconstruction over 3 years. Surgeons’ concern on
qualitative outcome increases the likelihood of discussion regarding breast reconstruction
with patients (B=4.833, p=0.044).
Data from 302 patients (39 exclusion for incomplete responses) showed women
with reconstruction were younger (mean age 42 vs 50 years), more were working (69.4% vs
42.2%) and have prior awareness (90.3% vs 44.3%) compared to non-reconstruction group.
Commonest reasons for having reconstruction were ‘to feel more balanced’ (92.1%) and
‘surgeon’s strong recommendation’ (92.1%). Prior knowledge on breast reconstruction
increases likelihood of reconstruction (OR:5.805, p=0.026).
While no surgeons have concern on reconstructive surgery outcome, 21.8% patients
were unimpressed with previous outcome seen. Although 70% surgeons felt that patients
may not be interested in reconstruction, only 37.9% patients with prior awareness claim to
have no interest.
Conclusion
The study’s low reconstruction rate (20.6%) may be attributed to low referral.
Surgeons’ hypothetical criticisms may play some role in the referral rate. Patients’
likelihood to undergo reconstruction with surgeons’ recommendation and prior awareness
were reflective of surgeons’ strong influence on patient. Thus clarification on surgeons’
hypothetical criticisms may conceivably increase the reconstructive surgery rate.
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