Can specific preoperative counseling increase the likelihood a woman will choose postmastectomy breast reconstruction?

Background: Low reconstruction rates after mastectomy for breast cancer raise questions about the impact of preoperative education. This study determines whether counseling about reconstruction influences the decision about reconstruction. Methods: The study was based on a prospectively collected database of breast cancer surgery. Results: A total of 299 operations for breast cancer were performed. Of 127 mastectomies, 21 (16%) were not candidates. In all, 106 women were specifically educated about reconstruction; 40 (37%) women consulted with a plastic surgeon; and 22 (21%) women ultimately chose reconstruction. Forty women had the option of mastectomy or breast conservation. Twelve (30%) women accepted a consultation with a plastic surgeon. Six of these women (15%) ultimately chose reconstruction. Mastectomy was required in 66 women; 28 (42%) accepted a consultation with a plastic surgeon; 16 (24%) underwent reconstruction; 3 additional women are planning delayed reconstruction (28%). Conclusions: Reconstruction is more likely when mastectomy is required than when it is chosen. Low reconstruction rates reflect patient desire rather than access or education.