The attitude and perception of breast reconstruction by general surgeons in Saudi Arabia

Abstract

BACKGROUND AND OBJECTIVESPost-mastectomy breast reconstruction surgery had always been integral part in the approach to a patient with breast cancer. It is our aim of this study to report in a simplistic manner the variability in the perception and practice by surgeons surrounding breast reconstruction.DESIGN AND SETTINGSThis is a descriptive cross-sectional survey targeting a sample of general surgeons in 6 tertiary hospitals in Saudi Arabia from April 2012 to October 2012.METHODSA questionnaire adopted from the one designed by Spyrou et al was distributed to our sample of surgeons. It primarily focused on the surgeon’s attitude and perception of breast reconstruction surgery after mastectomy.RESULTSA total of 51 general surgeons were included in the study. Most of them, 24 (47.1%), worked in teaching hospitals. Thirty-six (70.6%) surgeons had a special interest in breast cancer management. Eighteen of them (35.5%) referred their patients for breast reconstruction. We observed that the surgeons of high-referral tendency were generally females (P=.016). More than half (33 [64.7%]), thought that a general surgeon is the one responsible for counseling patients. The majority (47%), disagreed with the notion that breast reconstruction can interfere with host defenses. Yet, (76.5 %) were concerned about masking local recurrence of the cancer, and 21 (41.2%) reported that patients refused such type of surgery. Forty-eight (94.1%) agreed that breast reconstruction has psychological benefits.CONCLUSIONIn Saudi Arabia, general surgeons have a high concern about masking local recurrence of the cancer despite the lack of evidence in the published reports. Nevertheless, less than half of the surgeons referred their cases for breast reconstruction. We recommend establishing national efforts to educate on the benefits of breast reconstruction and establish a tumor conference protocol on breast reconstruction including all involved specialties (oncologists and general and plastic surgeons).

The desire to utilize postmastectomy breast reconstruction in Saudi Arabian women

“…Post breast reconstruction morbidity and complications can be reduced by careful choice of reconstructive technique based on the patient’s individual circumstances. 4 We also found that patients with higher educational attainment were more likely to desire breast reconstruction. Some authors have reported that education and economic factors predispose a woman to opt for postmastectomy reconstruction.…”

“…Our findings indicate that for many breast cancer patients, misinformation can be a barrier to reconstruction. A previously published survey 4 reported the concern of general surgeons in Saudi Arabia that breast reconstruction might mask breast cancer recurrence, despite a lack of evidence for this in the literature. 4 Moreover, less than half of the surgeons referred their cases for breast reconstruction.…”

“…In a previously published study, almost half of the general surgeons surveyed reported that they had treated patients who refused breast reconstruction despite its availability. 4 Previous studies on the factors influencing postmastectomy breast reconstruction in the Middle East were conducted in Egypt 13 , 14 and we are not aware of any similar studies conducted in Saudi Arabia or the Gulf Region. The objectives of this exploratory study were to study the demographic and socioeconomic factors influencing the desire to utilize postmastectomy breast reconstruction and to evaluate the barriers to postmastectomy breast reconstruction among women in Saudi Arabia.…”

“… 3 Many types of breast reconstruction are available including silicone and silane implants, tissue expanders, and pedicle and free musculocutaneous flaps. 4 , 5 Although these reconstruction options have been proven to be oncologically safe, 5 and many women still refuse breast reconstruction. 6 The choice to proceed with breast reconstruction after mastectomy is difficult, and is affected by many factors.…”

The Approach of General Surgeons to Oncoplastic and Reconstructive Breast Surgery in Turkey: A Survey of Practice Patterns

“…In England, 65% of patients undergoing mastectomy without reconstruction reported received the correct information, while 45% claimed they were not offered the choice of reconstruction (13). A survey conducted among general surgeons in Saudi Arabia reported that reconstruction was proposed for 36% of patients undergoing mastectomy for breast cancer (14). As ORBS can improve quality of life, it is clearly important to offer it to this kind of patient.…”