When selecting a surgeon to perform breast reconstruction after mastectomy, most women rate reviews and personal recommendations as 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 in Durham, N.C,, 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

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, 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.

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.”