Sociodemographics, referral patterns, and internet use for decision-making in microsurgical breast reconstruction

Background: Increasing numbers of patients are choosing to undergo microsurgical breast reconstruction. Currently, no information is available about the sociodemographic profile, referral patterns, or decision-making process of women who choose this reconstructive modality. Methods: All women who underwent breast reconstruction at a single institution between 2004 and 2007 were surveyed regarding demographic information, referral patterns, and decision-making processes. For data analysis, the cohort was separated by reconstructive method: nonmicrosurgical reconstruction (i.e., implant, latissimus, and pedicled transverse rectus abdominis musculocutaneous flaps) or microsurgical reconstruction (i.e., free transverse rectus abdominis musculocutaneous, deep inferior epigastric artery perforator, superficial inferior epigastric artery, and superior gluteal artery perforator flaps). Results: Overall, 332 women were surveyed, with a response rate of 77 percent. Patients who underwent microsurgical reconstruction were more likely to be 40 to 49 years old (p = 0.014), whereas nonmicrosurgical patients were clustered at the extremes of age. Microsurgery patients self-referred to a reconstructive surgeon, whereas other patients were sent by surgical oncologists (p < 0.001). The Internet was an important decision-making aid to help microsurgery patients identify their reconstructive modality (p < 0.001). Compared with nonmicrosurgical counterparts, microsurgery patients were independent decision-makers and more active in choosing their reconstructive procedure (p = 0.001). Conclusions: Microsurgical breast reconstruction is highly sought after by a subset of patients with breast cancer. These patients are independent decision-makers in their health care choices. They use the Internet to learn about breast reconstruction techniques and are more likely to self-refer to a reconstructive surgeon. It remains unclear how many patients would choose microsurgical reconstruction if offered more widely or if awareness of the procedure were greater.