In another new separate study reported at the ACS Clinical Congress, 92 percent of 313 patients who were referred for consultation underwent breast reconstruction. None of the 158 patients who were not referred had reconstructive surgery. "Patients who are being referred are much more likely to be reconstructed. If they aren't referred, the patients are not taking it upon themselves to find out about breast reconstruction. Patients should be given that option," said Beth Aviva Preminger, MD, MPH, an instructor in plastic surgery at Columbia University who conducted the study under the direction of Christine Rhode, MD, from New York Presbyterian Hospital, New York City.

The study emphasized the role of the breast surgeon as the gatekeeper for breast recon-struction procedures, Dr. Preminger said. "The breast surgeon is there for the treatment of cancer. The focus is obviously on getting the cancer out and treating the patients until they get well. Appropriately so. The question is whether breast surgeons are spending enough time discussing reconstruction with the patient, and if they're not, are they sending every patient to a plastic surgeon to be evaluated? Because breast surgeons do not necessarily always know who is or who isn't a good candidate for reconstruction," she added.

An emerging standard of care is to perform breast reconstruction immediately after cancer treatment so the patient can be spared another operation. "Patients can wake up from the operation thinking they have started on the way to recovery. But there are some instances when the patient is not a candidate for immediate reconstruction. These are issues that a plastic surgeon should have the opportunity to discuss with the patient. Our study underlines to general surgeons--breast surgeons in particular--the importance of sending patients to a plastic surgeon so patients can have that conversation and understand what their options are," Dr. Preminger explained.The study also has a message for patients. "Patients need to be advocates for their own care. They need to ask for a referral if they are not getting one, so they make an informed decision about their care," she concluded.Chen Chen, MD; Janet H. Yueh, MD; Minh-Doan Nguyen, MD, PhD; and Adam M. Tobias, MD, participated in the study of the computer-based decision-making aid.

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