Most general surgeons don't talk about breast reconstruction with women before cancer surgery, depriving them of information that can sway their decision about whether to have the whole breast or just a lump removed, a new study suggests.

Only one-third of the 1,178 women in the study said their general surgeons discussed cosmetic remedies with them in advance. When the topic did come up, women were four times more likely to choose mastectomy - removal of the whole breast - even though breast-conserving lumpectomies usually suffice.

It was unclear why women who discussed reconstruction preferred mastectomy, but reconstruction options such as implants are not suitable for fixing odd-shaped defects left after lumpectomies.

"Our point is not to say that one decision is better than another, but that women need to know all their options," said Amy Alderman, the University of Michigan plastic surgeon who led the study. "There are positives and negatives to both. We shouldn't be paternalistic and tell patients, 'This is what you need.' "

The study is online today in Cancer and will be in the journal's Feb. 1 print issue.

Women who see breast specialists rather than general surgeons may be more likely to be sent to plastic surgeons for consultations about reconstruction, experts said.

They said the latest study, done in more than 100 hospitals in the Detroit and Los Angeles areas, may overstate the doctor-patient communication problem, but they acknowledge that one exists.

"I would bet that we have been so obsessed with treatment that this quality-of-life issue is one we just haven't focused on," said Otis Brawley, chief medical officer at the American Cancer Society.

Breast cancer is the most common cancer in American women. More than 178,000 new cases are expected this year in the United States, and more than one million worldwide.

For cancer that has not spread, most women have a lumpectomy, but some need or prefer a mastectomy. The new study surveyed women three months after breast cancer surgery, from 2001 to 2003, to see whether knowing about reconstruction swayed the treatment choice.

Younger women, average age 56, were more likely to have discussed this option than older ones, average age 61. (the average age was 56 for those who did versus 61 for those who did not). More educated women also were more likely to discuss it.

The study, paid for by the National Cancer Institute, did not ask who brought up the topic, patient or doctor.

Treatment guidelines do not spell out what doctors should say and when, so "this study is likely to get some traction," Brawley said.