Abdominoplasty Consent Forms DoNot Caution against the Potential Lossof a Reconstructive Option forBreast Reconstruction

Abstract

Sir: More than 1.2 million cases of breast cancer in women occur worldwide annually.1 Breast cancer is the most frequently diagnosed malignancy in women worldwide.1 Twenty-two percent of new cancer cases in women are due to breast cancer.1 The lifetime probability of a woman developing breast cancer worldwide is one in eight.1 Death rates from breast cancer have steadily decreased in women since 1990.2 This decrease is due to a combination of earlier detection and improved treatment. Fewer than 20 percent of eligible women undergo breast reconstruction after treatment for breast cancer.3 For these women undergoing mastectomy, significant advances in reconstruction techniques provide several options for breast reconstruction.4 The abdominal wall represents a major source of tissue for autologous breast reconstruction.4 It provides the most sizeable tissue for the breast mound and provides sufficient tissue for bilateral breast reconstruction.4 Among technical alternatives, abdominal flaps have been recommended as the option of choice to produce the most natural results.4 A total of 140,155 women had an abdominoplasty in 2006 in the United States.5 This is a 36 percent increase in patients undergoing abdominoplasty since 2004 and a 132 percent increase since 2000.5 The incidence of women undergoing abdominoplasty and women developing breast cancer is so high that they may frequently occur metachronously in the same patient, so there must be prudence that the consequences of abdominoplasty might reduce future potential options in the course and outcome of reconstructive breast cancer therapy, particularly in women with a high risk of future breast cancer. Patients rely on surgeons for guidance. We collected 83 preprinted abdominoplasty consent forms from hospitals worldwide in Arabic, Chinese, English, Finnish, French, German, Italian, Portuguese, Russian, Spanish, and Ukrainian. These consent forms were examined to see whether they stated that abdominoplasty may reduce future potential options in the course and outcome of reconstructive breast cancer therapy. None of these 83 consent forms mentioned this potential future consequence. We advocate that female patients who wish to undergo abdominoplasty are informed that they may lose a potential option for breast reconstruction to receive enough information on which to base their decision. Ensuring that patients are appropriately and adequately informed ensures that they can make a rational decision about their treatment and sits well with worldwide medical and governmental recommendations to that effect. ACKNOWLEDGMENTS The authors acknowledge the help of Dr. Lennard Chan, Dr. Andrew Lindford, Dr. Carlos Neves, and Dr. Rostislav Shevchenko in the collection and translation of abdominoplasty consent forms. Sammy Al-Benna, M.R.C.S., Ph.D. Department of Plastic and Reconstructive Surgery The Royal London Hospital London, United Kingdom Said S. Al-Busaidi, M.D., M.R.C.S. Department of Plastic and Reconstructive Surgery Khoula Hospital Muscat, Sultanate of Oman Georgios Papadimitriou, M.D. Department of Plastic Surgery Euroclinic of Athens Athens, Greece Fabrizio Schonauer, M.D. Department of Plastic Surgery University of Naples “Federico II” Naples, Italy Lars Steinstrasser, M.D. Klinik für Plastische Chirurgie und Schwerbrandverletzte BG Kliniken Bergmannsheil Ruhr-Universität Bochum, Germany