The authors of this paper should be commended for attempting to shed light on the etiology of low rates of breast reconstruction after mastectomy. Their results were stratified by age and by whether mastectomy was elected or required because of diagnosis and clinical presentation. Their Conclusions suggest that low reconstructive rates reflect patient desire rather than preoperative education or access.
Two factors not addressed in this study were the content of the preoperative counseling and the surgical options available to the patients. In the United States, most breast reconstruction involve the use of implants. Most plastic surgeons recognize that autogenous reconstruction provides a more natural permanent result than do other methods. Unfortunately, the most commonly used autogenous reconstruction techniques are limited by the donor site morbidity inherent in the muscle sacrifice. Breast reconstruction became more desirable when perforator and muscle-sparing techniques were developed, but not all patients have access to state-of-the-art techniques.
Plastic surgeons are duty-bound to make breast reconstruction more desirable for patients to enhance the quality and minimize the morbidity of breast reconstruction/ Multidisciplinary breast cancer teams must ensure that patients receive complete education concerning their surgical options, and such teams must advocate access to the highest quality of breast reconstruction rates, but in a different context that the author's conclusions imply.
J.E. Craigie, MD R.J. ALLEN, MD