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J Reconstr Microsurg 2022; 38(05): 361-370
DOI: 10.1055/s-0041-1733977
Original Article

Does Surgeon Training Affect Patient Perception of Surgeon Skill in DIEP Flap Breast Reconstruction?

Deepa Bhat
1   Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
,
Tejas Kollu
1   Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
,
Tinatini Giutashvili
2   Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
,
Ashit Patel 
1   Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
,
Joseph A. Ricci
3   Division of Plastic Surgery, Department of Surgery, Montefiore Medical Center, Bronx, New York
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Abstract

Background The aim of this study is to investigate whether a surgeon's training background and years of experience advertised on a social media platform influences perception of surgeon competence, patient recruitment likelihood, and referral likelihood.

Methods A mockup of an Instagram post was created using a before and after picture of a deep inferior epigastric perforator (DIEP) flap patient. The caption under each post was changed to reflect one of six possible training categories: 1 year of experience, 10 years of experience, 20 years of experience, fellowship, Ivy League training, and a null case (with no training information against which all other cases were compared). Surveys asked female responders to evaluate surgeon competence, likelihood of becoming a patient, and likelihood of making a referral to their friends or family. Amazon MTurk crowdsourcing platform was used to distribute the survey.

Results A total of 1,878 responses were recorded, with the majority identifying as Caucasian (59%). The surgeon with 20 years of experience had the highest patient recruitment scores when compared with the null, 1 year, 10 year, and Ivy League training backgrounds (p = 0.0314, p = 0.0065, p = 0.0207, and p = 0.0244, respectively). The majority of responders (67%) preferred a female surgeon. Responders with a history of breast reconstruction assigned lower surgeon competence scores compared with women without a history of breast cancer (p <0.0001). Women who underwent breast reconstruction were also less likely to make referrals to their family and friends (p <0.0001).

Conclusion Surgeon's experience influences whether a patient is likely to seek care from a plastic surgeon. Personal history of breast cancer has a negative impact on perceived surgeon competence as well as patient recruitment likelihood and referral likelihood. Emphasizing fewer years of training or Ivy League training did not make an appreciable difference in patient perception of competence or likelihood of recruiting a new patient.

Keywords

breast reconstruction - DIEP flap - Instagram - patients choice - surgeon training

Previous Presentation

This work has not previously been published or presented.




Publication History

Received: 06 February 2021

Accepted: 22 June 2021

Article published online:
28 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bhat D, Ricci JA, Patel A. Implicit bias in social media: surgeon name affects patient perception of surgical competence. Plast Reconstr Surg 2020; 147 (06) 948-956
    CrossrefPubMedGoogle Scholar
  • 2 Greene J, Hibbard JH, Sacks RM. Does the race/ethnicity or gender of a physician's name impact patient selection of the physician?. J Natl Med Assoc 2018; 110 (03) 206-211
    PubMedGoogle Scholar
  • 3 Bucknor A, Christensen J, Kamali P. et al. Crowdsourcing public perceptions of plastic surgeons: is there a gender bias?. Plast Reconstr Surg Glob Open 2018; 6 (04) e1728-e1728
    CrossrefPubMedGoogle Scholar
  • 4 Huis In 't Veld EA, Canales FL, Furnas HJ. The impact of a plastic surgeon's gender on patient choice. Aesthet Surg J 2017; 37 (04) 466-471
    PubMedGoogle Scholar
  • 5 Zhao C, Dowzicky P, Colbert L, Roberts S, Kelz RR. Race, gender, and language concordance in the care of surgical patients: a systematic review. Surgery 2019; 166 (05) 785-792
    CrossrefPubMedGoogle Scholar
  • 6 Solnick RE, Peyton K, Kraft-Todd G, Safdar B. Effect of physician gender and race on simulated patients' ratings and confidence in their physicians: a randomized trial. JAMA Netw Open 2020; 3 (02) e1920511
    CrossrefPubMedGoogle Scholar
  • 7 Farnum RA. Prestige in the Ivy League: Meritocracy at Columbia. Harvard and Penn; 1990
    Google Scholar
  • 8 Oprisko R, Dobbs K, DiGrazia J. Pushing up ivies: institutional prestige and the academic caste system. Georget Public Policy Rev 2013. Available at: http://gppreview.com/2013/08/21/pushing-up-ivies-institutional-prestige-and-the-academic-caste-system/
    PubMedGoogle Scholar
  • 9 Herrera FA, Chang EI, Suliman A, Tseng CY, Bradley JP. Recent trends in resident career choices after plastic surgery training. Ann Plast Surg 2013; 70 (06) 694-697
    CrossrefPubMedGoogle Scholar
  • 10 Tse RW, Oh E, Gruss JS, Hopper RA, Birgfeld CB. Crowdsourcing as a novel method to evaluate aesthetic outcomes of treatment for unilateral cleft lip. Plast Reconstr Surg 2016; 138 (04) 864-874
    CrossrefPubMedGoogle Scholar
  • 11 Adami H-O, Malker B, Holmberg L, Persson I, Stone B. The relation between survival and age at diagnosis in breast cancer. N Engl J Med 1986; 315 (09) 559-563
    CrossrefPubMedGoogle Scholar
  • 12 Cimprich B, Ronis DL, Martinez-Ramos G. Age at diagnosis and quality of life in breast cancer survivors. Cancer Pract 2002; 10 (02) 85-93
    CrossrefPubMedGoogle Scholar
  • 13 Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA. (eds). SEER Cancer Statistics Review, 1975-2018, National Cancer Institute. Bethesda, MD: https://seer.cancer.gov/csr/1975_2018/ . Accessed: December 3, 2020
    Google Scholar
  • 14 Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Semin Oncol 2009; 36 (03) 237-249
    CrossrefPubMedGoogle Scholar
  • 15 Wilkins EG, Hamill JB, Kim HM. et al. Complications in postmastectomy breast reconstruction: one-year outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Ann Surg 2018; 267 (01) 164-170
    CrossrefPubMedGoogle Scholar
  • 16 Ashikari RH, Ashikari AY, Kelemen PR, Salzberg CA. Subcutaneous mastectomy and immediate reconstruction for prevention of breast cancer for high-risk patients. Breast Cancer 2008; 15 (03) 185-191
    CrossrefPubMedGoogle Scholar
  • 17 Brennan ME, Flitcroft K, Warrier S, Snook K, Spillane AJ. Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer. Breast 2016; 30: 59-65
    CrossrefPubMedGoogle Scholar
  • 18 Nelson JA, Fosnot J, Selber JC, Wu LC, Serletti JM. Age and abdominal wall strength: assessing the aging abdominal wall after autologous breast reconstruction. Microsurgery 2013; 33 (01) 14-23
    CrossrefPubMedGoogle Scholar
  • 19 La Padula S, Hersant B, Noel W. et al. Use of the retrograde limb of the internal mammary vein to avoid venous congestion in DIEP flap breast reconstruction: further evidences of a reliable and time-sparing procedure. Microsurgery 2016; 36 (06) 447-452
    CrossrefPubMedGoogle Scholar
  • 20 Lee K-T, Mun G-H. Volumetric planning using computed tomographic angiography improves clinical outcomes in DIEP flap breast reconstruction. Plast Reconstr Surg 2016; 137 (05) 771e-780e
    CrossrefPubMedGoogle Scholar
  • 21 Hunsinger V, Marchac A, Derder M. et al. A new strategy for prophylactic surgery in BRCA women: combined mastectomy and laparoscopic salpingo-oophorectomy with immediate reconstruction by double DIEP flap. Paper presented at: Annales de Chirurgie Plastique Esthétique. 2016
    PubMedGoogle Scholar
  • 22 Chatterjee JS, Lee A, Anderson W. et al. Effect of postoperative radiotherapy on autologous deep inferior epigastric perforator flap volume after immediate breast reconstruction. Br J Surg 2009; 96 (10) 1135-1140
    CrossrefPubMedGoogle Scholar
  • 23 Cubitt J, Barber Z, Khan AA, Tyler M. Breast reconstruction with deep inferior epigastric perforator flaps. Ann R Coll Surg Engl 2012; 94 (08) 552-558
    CrossrefPubMedGoogle Scholar
  • 24 Dusch MN, O'Sullivan PS, Ascher NL. Patient perceptions of female surgeons: how surgeon demeanor and type of surgery affect patient preference. J Surg Res 2014; 187 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 25 Childs AJ, Friedman WH, Schwartz MP, Johnson M, Royek AB. Female patients' sex preferences in selection of gynecologists and surgeons. South Med J 2005; 98 (04) 405-408
    CrossrefPubMedGoogle Scholar
  • 26 Cil TD, Easson AM. The role of gender in patient preference for breast surgical care—a comment on equality. Isr J Health Policy Res 2018; 7 (01) 37
    CrossrefPubMedGoogle Scholar
  • 27 Groutz A, Amir H, Caspi R, Sharon E, Levy YA, Shimonov M. Do women prefer a female breast surgeon?. Isr J Health Policy Res 2016; 5: 35
    CrossrefPubMedGoogle Scholar
  • 28 Reid I. Patients' preference for male or female breast surgeons: questionnaire study. BMJ 1998; 317 (7165): 1051-1060
    CrossrefPubMedGoogle Scholar
  • 29 Sbitany H, Amalfi AN, Langstein HN. Preferences in choosing between breast reconstruction options: a survey of female plastic surgeons. Plast Reconstr Surg 2009; 124 (06) 1781-1789
    CrossrefPubMedGoogle Scholar
  • 30 Katz SJ, Hofer TP, Hawley S. et al. Patterns and correlates of patient referral to surgeons for treatment of breast cancer. J Clin Oncol 2007; 25 (03) 271-276
    CrossrefPubMedGoogle Scholar
  • 31 Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998; 228 (03) 320-330
    CrossrefPubMedGoogle Scholar
  • 32 Waljee JF, Hawley S, Alderman AK, Morrow M, Katz SJ. Patient satisfaction with treatment of breast cancer: does surgeon specialization matter?. J Clin Oncol 2007; 25 (24) 3694-3698
    CrossrefPubMedGoogle Scholar
  • 33 Schmauss D, Machens H-G, Harder Y. Breast reconstruction after mastectomy. Front Surg 2016; 2: 71
    CrossrefPubMedGoogle Scholar
  • 34 Dobele AR, Ward T. Enhancing word-of-mouth referrals. Paper presented at: ANZMAC 2003 Conference Proceedings. Adelaide: Central Queensland University; 2003
    PubMedGoogle Scholar
  • 35 Corkum JP, Butler K, Zhong T. Higher distress in patients with breast cancer is associated with declining breast reconstruction. Plast Reconstr Surg Glob Open 2020; 8 (02) e2636
    CrossrefPubMedGoogle Scholar
  • 36 McInnes JA, Knobf MT. Weight gain and quality of life in women treated with adjuvant chemotherapy for early-stage breast cancer. Oncol Nurs Forum 2001; 28 (04) 675-684
    PubMedGoogle Scholar
  • 37 Northouse LL, Mood D, Kershaw T. et al. Quality of life of women with recurrent breast cancer and their family members. J Clin Oncol 2002; 20 (19) 4050-4064
    CrossrefPubMedGoogle Scholar
  • 38 Redeker NS, Lev EL, Ruggiero J. Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 2000; 14 (04) 275-290 , discussion 291–298
    PubMedGoogle Scholar
  • 39 Sheehan J, Sherman KA, Lam T, Boyages J. Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology 2007; 16 (04) 342-351
    CrossrefPubMedGoogle Scholar
  • 40 Roth RS, Lowery JC, Davis J, Wilkins EG. Psychological factors predict patient satisfaction with postmastectomy breast reconstruction. Plast Reconstr Surg 2007; 119 (07) 2008-2015
    CrossrefPubMedGoogle Scholar
  • 41 Pirro O, Mestak O, Vindigni V. et al. Comparison of patient-reported outcomes after implant versus autologous tissue breast reconstruction using the BREAST-Q. Plast Reconstr Surg Glob Open 2017; 5 (01) e1217
    CrossrefPubMedGoogle Scholar
  • 42 Nelson JA, Allen Jr RJ, Polanco T. et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients. Ann Surg 2019; 270 (03) 473-483
    CrossrefPubMedGoogle Scholar
  • 43 Damen TH, Timman R, Kunst EH. et al. High satisfaction rates in women after DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg 2010; 63 (01) 93-100
    CrossrefPubMedGoogle Scholar
  • 44 Joyce CW, Murphy S, Murphy S, Kelly JL, Morrison CM. Scar wars: preferences in breast surgery. Arch Plast Surg 2015; 42 (05) 596-600
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Momoh AO, Griffith KA, Hawley ST. et al. Patterns and correlates of knowledge, communication, and receipt of breast reconstruction in a modern population-based cohort of patients with breast cancer. Plast Reconstr Surg 2019; 144 (02) 303-313
    CrossrefPubMedGoogle Scholar
  • 46 Tseng JF, Kronowitz SJ, Sun CC. et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer 2004; 101 (07) 1514-1523
    CrossrefPubMedGoogle Scholar
  • 47 Ishii CH. Current update in Asian rhinoplasty. Plast Reconstr Surg Glob Open 2014; 2 (04) e133
    CrossrefPubMedGoogle Scholar
  • 48 Zelken J, Cheng MH. Asian breast augmentation: a systematic review. Plast Reconstr Surg Glob Open 2015; 3 (11) e555
    CrossrefPubMedGoogle Scholar
  • 49 Mets EJ, Chouairi FK, Gabrick KS, Avraham T, Alperovich M. Persistent disparities in breast cancer surgical outcomes among Hispanic and African American patients. Eur J Surg Oncol 2019; 45 (04) 584-590
    CrossrefPubMedGoogle Scholar
  • 50 Morrow M, Li Y, Alderman AK. et al. Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg 2014; 149 (10) 1015-1021
    CrossrefPubMedGoogle Scholar
  • 51 Sergesketter AR, Thomas SM, Lane WO. et al. Decline in racial disparities in postmastectomy breast reconstruction: a surveillance, epidemiology, and end results analysis from 1998 to 2014. Plast Reconstr Surg 2019; 143 (06) 1560-1570
    CrossrefPubMedGoogle Scholar
  • 52 Wilkins EG, Alderman AK. Breast reconstruction practices in North America: current trends and future priorities. Paper presented at: Seminars in Plastic Surgery. 2004
    PubMedGoogle Scholar
  • 53 Rubin LR, Chavez J, Alderman A, Pusic AL. ‘Use what God has given me’: difference and disparity in breast reconstruction. Psychol Health 2013; 28 (10) 1099-1120
    CrossrefPubMedGoogle Scholar
  • 54 Martinez-Ramos GP, Biggs MJG, Lozano Y. Quality of life of Latina breast cancer survivors: from silence to empowerment. Adv Soc Work 2013; 14 (01) 82-101
    CrossrefPubMedGoogle Scholar
  • 55 Alderman AK, Hawley ST, Janz NK. et al. Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population- based study. J Clin Oncol 2009; 27 (32) 5325-5330
    CrossrefPubMedGoogle Scholar
  • 56 Buki LP, Reich M, Lehardy EN. “Our organs have a purpose”: body image acceptance in Latina breast cancer survivors. Psychooncology 2016; 25 (11) 1337-1342
    CrossrefPubMedGoogle Scholar
  • 57 Herruer JM, Prins JB, van Heerbeek N, Verhage-Damen GWJA, Ingels KJAO. Negative predictors for satisfaction in patients seeking facial cosmetic surgery: a systematic review. Plast Reconstr Surg 2015; 135 (06) 1596-1605
    CrossrefPubMedGoogle Scholar
  • 58 Statista. Distribution of Instagram users worldwide as of January 2020, by age group. Accessed December 5. 2020 at: https://www.statista.com/statistics/325587/instagram-global-age-group/ Published 2020
    PubMedGoogle Scholar
  • 59 Contant CM, van Wersch AM, Wiggers T, Wai RTJ, van Geel AN. Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy. Patient Educ Couns 2000; 40 (03) 201-208
    CrossrefPubMedGoogle Scholar