Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3380–3388 | Cite as

Striving to Do No Harm and Yet Respect Patient Autonomy: Plastic Surgeons’ Perspectives of the Consultation for Breast Reconstruction with Women Who Have Early-Stage Breast Cancer

  • Selina SchmockerEmail author
  • Lesley Gotlib Conn
  • Erin D. Kennedy
  • Toni Zhong
  • Frances C. Wright
Breast Oncology



Rates of contralateral prophylactic mastectomy (CPM) have doubled over the last decade among women considered low risk for developing contralateral breast cancer. Despite the strong association between CPM and breast reconstruction, little is known about the clinical encounter between patients and plastic surgeons. A qualitative study was performed to understand how plastic surgeons describe their roles in the treatment decision-making process through their consultations with women who have unilateral early-stage breast cancer.


Semi-structured interviews with Ontario plastic surgeons were conducted. An inductive and interpretive thematic approach was initially used to analyze the data. The four principles of biomedical ethics then served as the conceptual lens to interpret the findings.


The participants in this study were 18 plastic surgeons, and data saturation was reached. Four themes were identified: maintaining non-maleficence, supporting patient autonomy, delivering (un)equal health care, and providing care to enhance well-being. The ongoing push-pull between competing ethical principles was the overarching theme, specifically, striving to balance parallel responsibilities to do no harm while also respecting patients’ rights to make their own healthcare decisions.


In this patient-centric climate, it is important to acknowledge that patients may value outcomes such as achieving greater peace of mind above other clinical factors and are willing to incur additional risks to achieve these goals. Shared decision-making will help to reveal the rationale underlying each individual’s treatment choice, which in turn will allow physicians to appropriately weigh patient requests with the best available medical evidence when counseling women on decision-making for breast cancer care.



The authors declare that they have no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Selina Schmocker
    • 1
    Email author
  • Lesley Gotlib Conn
    • 2
  • Erin D. Kennedy
    • 1
    • 3
    • 4
  • Toni Zhong
    • 5
    • 6
  • Frances C. Wright
    • 4
    • 7
  1. 1.Zane Cohen Centre for Digestive DiseasesMount Sinai HospitalTorontoCanada
  2. 2.Evaluative Clinical Sciences and the Tory Trauma Research ProgramSunnybrook Research InstituteTorontoCanada
  3. 3.Division of General Surgery, Department of SurgeryMount Sinai HospitalTorontoCanada
  4. 4.Division of General Surgery, Department of SurgeryUniversity of TorontoTorontoCanada
  5. 5.Department of Surgery, University Health NetworkToronto General HospitalTorontoCanada
  6. 6.Department of Surgical Oncology, University of Toronto, University Health NetworkToronto General HospitalTorontoCanada
  7. 7.Division of General SurgerySunnybrook Health Sciences CentreTorontoCanada

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