The term shared decision-making can be used across multiple disciplines in medicine. The process of shared decision-making takes place when a patient and their health care provider work together to make a health care plan that is best for the patient. It is a topic I speak of often in my community as a patient advocate for all options of breast reconstruction after mastectomy. Let’s talk about shared decision making and how it works in breast reconstruction.
How Shared Decision-Making Works for the Patient
Whether implants are chosen or you choose to use your own tissue, being your own best advocate and doing your homework prior to your initial consult is beneficial. Prepare your questions and findings ahead of time. Your physician will go to the consult prepared. Doesn’t it make sense then, that you are just as prepared?
This first step will empower you with a voice to communicate with your surgeon. Having this information will give you a sense of being a team member in the conversation with your plastic surgeon. This is a lifetime decision. Take the extra time to research the breast reconstruction procedure you feel you want to have.
Because you will be consulting with a plastic surgeon, know what your expected aesthetic outcomes are. This can include:
- Size of your breasts after reconstruction.
- Scar placement (both at the breasts and other parts of the body) if you choose to use your own tissue.
Additional questions to discuss during a shared decision-making conversation can include:
- Will any sensation to the breasts be present and noticeable after reconstruction surgery?
- When can I return to work and to my exercise routine?
- How many drains will I have after surgery?
- What are the risks and benefits of each type of surgery: (implant-based vs. autologous)?
- How many surgeries will this involve?
- Do you know of any support groups you can recommend with patients who have had reconstruction I can talk to?
It is in your best interest as a patient to ask the following about the surgeons’ qualifications.
- How many procedures have you performed?
- What is the success rate of your flap surgeries?
- Do you work with another surgeon who has your skill level?
The Role of the Plastic Surgeon in Shared Decision-Making
The plastic surgeon will give the patient all their options for breast reconstruction. In many instances, a patient may already have in mind what procedure they wish to have. The surgeon will share evidence-based research about the procedure the patient is considering. Based on their clinical practice and skill level, they will share with the patient what they feel they can realistically achieve for them.
The discussion involves listening from both the patient and surgeon. This is the basis for the relationship of trust that develops in a true shared decision-making consult in plastic surgery for breast reconstruction.
I feel it is important for patients and physicians to be aware of any opportunities to enhance their role and participation in shared decision making. We are exclusive individuals in the plastic surgery consult. We bring to the table our own personalities, skills, abilities, research, and backgrounds.
I feel it is of great value for all parties involved, both patients and surgeons, to discuss practices they have used and what does and doesn’t work in a shared decision-making setting. Then we can continue to improve the breast reconstruction journey for the patient and improve the practice of the surgeon. A win/win for both!
Did you feel you engaged in a shared decision-making conversation with your plastic surgeon for you breast reconstruction? How did you prepare for your consult and come to your decision? Did it make a difference in your experience? I would love to hear from you. It will be a great learning opportunity for me as a patient advocate.
My reconstruction experience was anything but pleasant. While I shared my wishes with my PT, he had his own perception of what women would want and kept pushing me to expand even further so that I would have ultimately, larger breasts than what I originally had. I was very clear with him that I didn’t want anything larger than what I originally had, but what was most discouraging was the fact that during what was one of my weakest times during the whole BC journey, I had to really stand strong and almost fight for what I preferred. I’m so appreciative of the work you do in ensuring PT’s are aware of the patient in this whole process and your work in making sure the patient voice is heard.
Claudia, I am truly sorry to hear about your experience. We cannot sugar coat the fact not everyone has the opportunity to engage in a shared decision making experience in plastic surgery and breast reconstruction. Being vulnerable after a diagnosis is difficult for patients to find a strong voice when making these tough decisions about surgery. I applaud you for fighting for what you preferred and being your own best advocate. Thank you for your kind words. I intend to stay the course as long as I can to bring empowerment and awareness for patients about this important topic in plastic surgery and breast reconstruction. Always great to hear from you! ~ Terri
Hi Terri,
There was no information given to me before my mastectomy and reconstruction.
First,I had no idea who was a good plastic surgeon so the hospital choose my surgeons.
….It was who ever matched up in the schedule. Once I had their names, I found out the plastic surgeon also worked on a friend of a friend’s wife….and she was apparently happy with her results.
When I originally talked with my PS he totally discouraged me from doing a double mastectomy…telling me it was double the healing time and double the risk that something could go wrong! I soo regret not having both breasts removed!
I was never told about any options except an implant, and Dr Carty…who I have learned about on this sight, is in the same office as my initial PS!! I have had two more implants since the original reconstruction, and a total of three plastic surgeons. None of them offered, or mentioned DIEP surgery. In September I met with Dr. Isreali in New York, he was the first surgeon to go through the surgery step by step. I believe it should be mandatory that we are given pamphlets on all procedures available for reconstruction, not just what the consulting plastic surgeon can offer. Sadly that is how I was handled. Maybe the diagnosing doctor should be giving out this information, not the plastic surgeon office. Thanks for all of your support and guidance!
Hello Lori and thank you for sharing your story. The Breast Cancer Patient Education Act was passed in December of 2015. However, we still have work to do. As you said, not all patients are informed by their healthcare team. This could be a primary care doctor, oncologist, breast surgeon, or plastic surgeon. Support groups are now an integral part of that shared information. We have a lot of work to do to continue educating physicians and patients on the shared decision making model. I hope your strong voice brings a sense of closure and success to an already difficult Journey you have been through. It’s always good to hear the strong voices of patients. Thanks Lori! ~ Terri