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

Abstract

Background and objectives: Post-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 settings: This 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.

Methods: A 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.

Results: A 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.

Conclusion: In 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).

Figure 1

Hypothetical criticism of breast reconstruction. Surgeons’ level of agreement in percentage.

Figure 2

Measures to increase the accessibility to breast reconstruction surgery. Adopted from “Association of Breast Surgery at BASO, the British Association of Plastic, Reconstructive and Aesthetic Surgeons and the Training Interface Group in Breast Surgery. Oncoplastic Breast Surgery—A guide to good practice.”