By NATASHA SINGER


For many cancer patients undergoing mastectomies, reconstructive breast surgery can seem like a first step to reclaiming their bodies.

But even as promising new operations are gaining popularity at academic medical centers, plastic surgeons often fail to tell patients about them. One reason is that not all surgeons are trained in the latest procedures. Another reason is money: some complex surgeries are less profitable for doctors and hospitals, so they have less incentive to offer them, doctors say.

“It is clear that many reconstruction patients are not being given the full picture of their options,”said Diana Zuckerman, the president of the National Research Center for Women and Families, a nonprofit group in Washington.

One patient, Felicia Hodges, a 41-year-old magazine publisher in Newburgh, New York, chose to undergo a double mastectomy after she was found to have cancer of the right breast in 2004. She consulted a plastic surgeon, who offered her only reconstruction with breast implants, she said.

Ms.Hodges chose implants filled with saline. She developed woundhealing problems that required her surgeon to remove her right implant, and she was left with a concave chest with a hole roughly 24 millimeters wide, she said; she described the experience as“worse than the mastectomy.”

Then Ms.Hodges discovered a chat room on the Web site breastcancer.
org, where women share detailed information about breast reconstruction . There she learned of newer, more complex procedures that involve transplanting a wedge of fat and blood vessels from the abdomen or buttocks, which is refashioned to form new breasts.

“It’s unfortunate that a lot of general surgeons, breast surgeons and plastic surgeons don’t mention it,”Ms.Hodges said. She underwent one of the surgeries, known as a GAP flap, last year. An athlete and martial-arts enthusiast, she has now resumed her karate practice.

But for many patients, the options may be limited because their doctors are not proficient in the latest procedures. Dr.Michael F.McGuire, the president-elect of the American Society of Plastic Surgeons, said it was not unusual for surgeons to omit telling patients about operations they do not perform.

Uneven information about reconstructive options is part of a larger problem, said Dr.Amy K.Alderman, an assistant professor of plastic surgery at the University of Michigan Medical School. Only one third of women undergoing operations for breast cancer said their general surgeons had discussed reconstruction at all, according to a study by Dr.Alderman of 1,844 women in Los Angeles and Detroit that was published in February in the journal Cancer.

About 66,000 women in the United States had mastectomies in 2006, the latest figures available, according to the federal government. Mastectomy rates vary, with Central and Eastern Europe having the highest at 77 percent, the United States 56 percent, and Western and Northern Europe 46 percent, according to a study in 2004. Breast cancer is the fifth leading cause of death worldwide, with 548,000 deaths in 2007, according to the World Health Organization.

An estimated 57,000 women had reconstructive breast surgery last year in the United States, with implant surgery being the most popular method. But implants come with the likelihood of future operations. Within four years of implant reconstruction, more than one third of patients in clinical studies had undergone a second operation, primarily to fix problems like ruptures and infections, according to studies submitted by implant makers to the federal government.

Complication rates for newer flap procedures like the one Ms.Hodges had have not been well studied, though many surgeons say they are less likely to require followup operations. The most common flap procedure, named a TRAM flap, after the rectus abdominis muscle, cuts away a portion of abdominal fat, as well as underlying muscle containing blood vessels, and uses the tissue to rebuild a breast. The procedure promises a more lifelike look and feel, but it carries a risk of a weaker abdominal wall and hernia.

Another flap method, the DIEP free flap, is the newest and most intricate, named for the abdomen’s deep inferior epigastric perforator vessels. It involves moving abdominal fat and blood vessels, but no muscle.

The DIEP flap was developed in 1992 by Dr.Robert J.Allen, a plastic surgeon in New York, New Orleans and Charleston, South Carolina. He often recommends that a prospective patient talk at length with patients who have had flap procedures.“Patients should not necessarily accept the first thing they hear as the end-all, because that is not necessarily the full story,”he said.