Abstract Introduction: Surgeons often serve as the “gatekeepers” of breast surgery, including decisions for post-mastectomy reconstruction. The options surgeons present and how recommendations are communicated can influence which treatments patients consider. This dynamic suggests that surgeon framing could play a key role in perpetuating or mitigating reconstruction disparities. We analyzed surgeon-patient consultations to describe surgeons’ discussion of reconstruction overall and by patient race. Methods: This study was a secondary analysis of Alliance clinical trial A231701CD. We included women aged ≤60 years who underwent breast cancer surgery without neoadjuvant therapy and had a transcript of their surgical consultation available (n=182). Transcripts were reviewed by 2 or more researchers to categorize discussions: preference for breast conserving surgery (BCS) without consideration of mastectomy or reconstruction, discussion of mastectomy but not reconstruction, or discussion of mastectomy with reconstruction. For consults with a reconstruction discussion, we coded who initiated the topic (surgeon vs patient/support person) and how reconstruction was presented (neutrally vs suggestion for or against). We generated summary statistics and used multivariable logistic regression models to identify factors associated with reconstruction discussions, with the first model including patient age alone and then adding race, insurance, and income. We used chi square test to assess differences in how reconstruction was presented by patient race. Results: Most patients were White (63%), with 23% Black and 10% Asian. Patient median age was 51 (range 28-60). A minority of consultations did not discuss reconstruction (preference for BCS 29%, n=53 or discussed mastectomy but not reconstruction 4%, n=8). Older patient age was associated with lower odds of discussing reconstruction. Black patient race was significantly associated with a lower odds of discussing reconstruction when controlling for age (Table), but not after inclusion of private insurance or income. Surgeons initiated the discussion in most consults (86%). Reconstruction was presented neutrally in 67% of consults, with surgeons making a suggestion for or against reconstruction in 27% and 6% of consults, respectively. There was no statistically significant difference in how reconstruction was presented by patient race (p=0.30). Discussion: Our findings suggest that Black patient race is associated with a lower odds of discussing reconstruction. The strength of this association was tempered by insurance type and income, although the pattern of findings remained consistent. This suggests that reconstruction disparities may partially stem from a lack of conversation during the initial surgical consultation. Additional work should focus on developing interventions to increase consistency in discussions about surgical options. Citation Format: F. Dickerson, M. C. Saucke, C. R. Breuer, J. R. Schumacher, H. B. Neuman. Role of surgeon discussions in post-mastectomy reconstruction racial disparities abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-16.
Dickerson et al. (Tue,) studied this question.