Women who undergo mastectomy for breast cancer are now offered reconstruction in line with national guidelines but the majority decline: A UK teaching hospital experience.

Abstract

The aim of this study was to evaluate what proportion of breast cancer patients were offered reconstruction following mastectomy (to assess compliance with national guidelines) and to consider the reasoning if patients were not given this option. Records of all mastectomies were obtained from a prospectively maintained database (September 2018-October 2019). The following were collected: demographics, indication for surgery, tumour properties, and indication for mastectomy over breast-conserving surgery. Clinic letters were used to determine whether patients were offered reconstruction and whether they accepted. If a patient was not offered reconstruction, the rationale for this was recorded. 201 mastectomies were carried out on 179 patients. 77.3% of women were offered reconstruction following mastectomy for cancer and 92.9% of women were offered reconstruction following mastectomy for non-invasive disease. Patients were not offered reconstruction only if they had significant co-morbidities (ASA grade III or higher); no patients who expressed an interest in reconstruction were declined. The most common reasons reconstruction was not offered included: deemed too frail following surgeon assessment (29.7%), advanced cancer (16.2%), and deemed high-risk following anaesthetist assessment (16.2%). 59.1% of patients who were offered reconstruction declined. Mean age in those who declined was significantly higher (P > 0.001). Our unit now complies with national guidelines when offering reconstruction to mastectomy patients; this service was not previously offered. Further research into the reasons behind why women are declining reconstruction is necessary to ensure we are providing adequate information in an appropriate format.