July 1, 2022 – Suppose you had to choose a surgeon to perform breast reconstruction after mastectomy for breast cancer: What would you base your decision on? For most women, factors like reviews and personal recommendations are more important than demographic factors, suggests a report in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
“When selecting a surgeon for breast cancer reconstruction, women place the highest value on surgeon reputation, including online reviews, personal recommendations, and education,” according to the study by ASPS Member Surgeon Scott T. Hollenbeck, MD, of Duke University Medical Center, Durham, NC, and colleagues. “In contrast, most women show no preference for surgeon demographics, such as surgeon gender and appearance.”
Online reviews and personal recommendations are key factors affecting choice of surgeon
Women being treated for breast cancer face a series of complex decisions, including whether to undergo breast reconstruction after mastectomy. In 2020, ASPS Member Surgeons performed more than 138,000 breast reconstruction procedures, according to ASPS statistics.
For many women, these challenges include the choice of oncologic surgeon to perform the initial mastectomy, as well as the plastic surgeon to perform breast reconstruction. Although these decisions are often guided by internal referral processes at major medical centers, the choice of reconstructive surgeon remains “a subjective process [that is] likely influenced by both patient characteristics and some degree of implicit bias,” the researchers write.
To explore factors affecting these decisions, Dr. Hollenbeck and colleagues performed an online survey with a general population of women, intended to emulate a population of breast cancer patients. The women were asked to imagine they had breast cancer requiring mastectomy and were choosing a surgeon for breast reconstruction.
The survey then asked about the importance of various factors that might affect the choice of surgeon, organized under demographics, such as the surgeon’s age, sex, or race/ethnicity; reputation, including online reviews, years of experience, or recommendation from family, friends, or other surgeons; and appearance, including the surgeon’s clothing and attractiveness. The analysis included responses from 990 women, median age 37 years. About 9% of the women reported having a personal experience with breast cancer.
Online reviews on physician-rating sites like Vitals.com or WebMD were the most important factor affecting surgeon selection: average rating 6.1 on a 7-point scale. This was followed closely by recommendations from another surgeon and years of experience, each with a rating of 5.7. Other key factors – with ratings around 5 – included recommendations from family or friends, attending a top medical school, having a surgeon located close to home, and having a surgeon who is well-dressed.
In contrast, the respondents ascribed low importance to demographic factors, including the surgeon’s gender or race/ethnicity; and to the surgeon’s overall appearance, aside from dressing professionally. Online advertising was also a low-rated factor.
Of the three groups of factors, reputation clearly had the greatest impact on the choice of a surgeon for breast reconstruction. There were some differences by respondent characteristics: older, more-educated, and higher-income women placed a higher value on the surgeon’s appearance. In younger women, there was a tendency to rate demographic factors higher, although this was not statistically significant.
Dr. Hollenbeck and coauthors conclude: “Overall, these findings lend insight into the patient decision-making process when choosing a surgeon for breast cancer reconstruction and underscore the importance of education and reputation over advertising and demographics.”
DOI: 10.1097/PRS.0000000000009194
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Plastic and Reconstructive Surgery® is published in the Lippincott portfolio by Wolters Kluwer.
About Plastic and Reconstructive Surgery
For over 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.
About ASPS
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
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