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Should immediate breast reconstruction be performed in the setting of radiotherapy? An ethical analysis
Gothenburg Univ, Sweden; Lund Univ, Sweden.
Gothenburg Univ, Sweden.
Gothenburg Univ, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Vastra Gotaland Reg, Sweden; Boras Univ, Sweden.ORCID iD: 0000-0003-0987-7653
2019 (English)In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764Article in journal (Refereed) Epub ahead of print
Abstract [en]

Immediate breast reconstruction (IBR) combined with post-mastectomy radiotherapy (PMRT) is associated with an increased risk for complications. Here, we analyse whether IBR combined with PMRT is ethically acceptable. We employ normative analysis following reflective equilibrium and the principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. From the perspective of beneficence and non-maleficence, we can choose either IBR or PMRT according to documented risks and complications, delayed autologous breast reconstruction with corresponding benefits but less risk for complications, or even no reconstruction, which for some women, might be equally beneficial. In such a situation, given the level of severity associated with lacking a breast after mastectomy, IBR violates the principles of beneficence and non-maleficence. To deny an IBR in the context of PMRT does not violate the principle of autonomy as it is normally interpreted in the healthcare system, not even when patient-centred care is taken into consideration. Moreover, there is a risk that the decision of the patient will be affected by heuristics, optimism bias, and surgeon bias. IBR in the context of PMRT could be in conflict with the principle of justice, as it could lead to displacement of care for other patient groups. Furthermore, an acceptable level of cost effectiveness should be low, given that living without a breast is a condition of moderate severity. In conclusion, given the current knowledgebase and established ethical norms within the healthcare system, we find strong ethical reasons not to offer IBR when PMRT is expected.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2019.
Keywords [en]
Plastic surgery; immediate breast reconstruction; radiotherapy; prioritizing; bioethics; guidelines
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-162318DOI: 10.1080/2000656X.2019.1688165ISI: 000495213300001PubMedID: 31702410OAI: oai:DiVA.org:liu-162318DiVA, id: diva2:1374046
Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2019-11-28

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