Breast Reconstruction in the US and Developing Countries

Pooja Patil and Dr. Lopamudra Das Roy

Breast reconstruction is the surgical process of reconstructing the shape and look of the breast after a mastectomy (breast removal). After a mastectomy, several women do not realize that there are options they can pursue concerning breast reconstruction. A mastectomy is almost always performed as a result of breast cancer and can result in a change in the way an individual’s breasts look. This significantly leads to self-confidence problems within women as the appearance of their breasts is changed and may not look the way society suggests. Mastectomies can result in feelings of shame or embarrassment, but what most do not know is the options for breast reconstruction. In some developed and developing countries, women are unaware of their options for breast reconstruction, some not even knowing that this is an option, which ultimately is damaging to their self-confidence [1].

Breast reconstruction surgery is currently unknown to several men and women as an option after their surgery and it is “provided to less than half of all women who need a mastectomy.” In addition to this, less than 20 percent of women undergo immediate reconstruction. Despite this, there is a study that claims 23% of women know that they have options for reconstruction, which is a smaller percentage than should be [2]. There are options for breast reconstruction including silicone or saline implants, or taking tissue from places like the back, thigh, buttocks, or belly to create a new breast.

Along with the methods given as options for breast reconstruction, it is important to understand the risks that can be associated with certain treatments as well. In some cases, a specific reconstruction method will not be possible. For example, radiation therapy can hinder the results of reconstruction surgery by causing infections or problems during wound healing. It is important to check with your plastic surgeon or oncologist regarding which type of reconstructive method is best when considering your personal medical history, age, health, etc. Also, studies show that reconstruction does not increase the chance of breast cancer returning or any difficulty in mammogram screening.

As there is the option for women to have one or both breasts removed, there are a variety of questions associated [2]. These questions are important to ask your plastic surgeon including the following: How many reconstruction surgeries will I need in total? What is the recovery time? Will I need recurring surgeries? Is it important to you for your breasts to look even in clothes such as bathing suits and bras? How much of your surgery will insurance cover? Breast reconstruction, although unknown to several, is a reliable option post-surgery.

Although post-mastectomy immediate breast reconstruction in the United States has been experiencing an upward trend due to increased awareness, the situation in India is taking longer to attend too. In a study conducted about breast reconstruction awareness among educated women in the metropolitan city of Mumbai, eight simple questions were asked to a sample population of one thousand women above twenty years of age. The study yielded the following results [3]:

The graphs and charts above indirectly demonstrate the situation in all of India. Since the survey was conducted exclusively in Mumbai among educated women, this is very telling of the awareness in rural, uneducated, and impoverished areas of India. Since it is a metropolitan area, it has all the cancer detection facilities, its treatment and rehabilitation alternatives are available not just in private hospitals but in all government hospitals as well. Besides, it has one of the largest plastic and reconstructive surgeons. Across the United States, the Women's Health and Cancer Rights Act was structured to guarantee women's access to post-mastectomy breast reconstruction through enforcing insurance cover for such procedures [1]. At the time of mastectomy, less than one-fifth of the women still undergo breast reconstruction. Considering the study the first one ever about awareness of breast reconstruction surgeries, it is hard to imagine the poor state that rural areas are in. Lack of awareness about the fact that breast reconstruction post-mastectomy is a part of the entire process and not a separate procedure needs to be understood and conveyed to each breast cancer patient accordingly.

It is important to take into account that the situation is inconvenient in all developing countries and needs attention. Although there are not many recent data cases in these countries, that which is provided is extremely alarming. Other than India, developing countries that are in dire need of resources and attention include Malaysia [4], South Africa [5] and several others.

When answering why the situation is so poor in these developing countries, the answer is very simple: money. Developing, third world countries do not have the facilities required to fund reconstruction. Also, the materials needed for reconstruction, such as the options which include silicone implants, etc. require surgical equipment and implants which are rather expensive. Despite this lack of financial funding, women and men are deprived of the knowledge concerning reconstruction surgery because of their accessibility to such institutions. Sometimes, when a person learns of breast cancer and the treatment options, the topic of reconstruction is not as highly regarded since surgery in a priority. In this hassle, it is possible to forget to mention reconstruction but this small error can have profound effects on some concerning confidence, retaliation, and social skills.

Surgical Options after Breast Cancer Surgery - Breast Cancer Hub Organized Webinar

With the financial situation in developing countries, people must look for safe clinics. The difficult aspect of the situation in developing countries includes the rather rural areas present. In most cases of developing countries, urban areas have larger clinics or hospitals that are in better shape than that of those in rural areas. To combat the issue of not having proper access to those located in rural areas versus urban, hospitals and clinics in urban areas should consider taking the time to venture out, send supplies, or provide funding for smaller facilities in rural areas [6]. With this, several people that may not have the ability to afford intensive care in a proper unit will still be provided the option of one, awarding the larger facility as well as keeping the men and women educated on their potential choices. In the long term, the importance of awareness concerning reconstruction facilities can help combat the risk of infection from performing these operations in less hygienic places.

When discussing and choosing a reconstruction method, if decided to proceed with one, it is important to discuss a treatment payment plan. By asking questions surrounding pricing strategy, people will be able to see how much the entire process is cost weighted, and how a payment plan can be set up. When developing countries come into question, financial aid is a large topic to be discussed with your respective doctor. Treatment plans including financial aid strategies are essential to understand. There is uncertainty with financial treatment for reconstruction as it is a personal yet stressful choice for most. Despite this, for a post-mastectomy patient to understand their treatment methods and cost-effective measures, means a step forward in their intended recovery [6].

Breast reconstruction financial aid, treatment, cost-effectiveness, safety, and locations where it is offered are all external issues that patients may deal with post-mastectomy. What is unspoken about by several and thought by even more is the internal problem that comes with breast reconstruction: self-confidence. What men and women do not talk about is their issues with self-confidence during these times. Being diagnosed with breast cancer and partaking in a mastectomy can hinder a person’s mental health. With the socioeconomic status issues and stigma surrounding sexism in the breast cancer field, both men and women face problems. According to the standards set by today’s society, breasts are a beauty determinant factor. People perceive breasts to be showing a woman’s beauty. Once they undergo a mastectomy, their self-confidence may deplete which is why several opt for reconstruction. For men, they may try to cover their surgery scars with a realistic fiction story or try to hide it from others as breast reconstruction is deemed a “woman’s cancer.” In today’s society, the fear of being looked down upon as being a breast cancer inhabitant outweighs that of being a breast cancer survivor. The reconstruction surgery is chosen to mask these surgery effects that alter the physical appearance of breasts in both men and women. Although this may be the situation in developed countries where the stigma is not as prevalent, developing countries are not the same amount of accepting.

Dr. Lopamudra Das Roy had traveled to India abroad where she performed various awareness camps. In these camps, she met with a woman who, after serious contemplation, decided to open up to Dr. Das Roy. As Dr. Das Roy was getting ready to perform a breast checkup, the young woman was asked to remove her bra. Dr. Das Roy was aware that this woman had undergone a mastectomy but what she was not aware of, is that when the woman removed her bra, the newspaper fell out of her bra. That is when she realized that the woman had stuffed her bra with newspapers to make her breasts seem even to the naked human eye. In rural areas especially, women face the issue of not being able to afford proper reconstruction so they feel the need to utilize such methods to appear “normal” to society. The heartbreaking fact of the matter is that this newspaper was an unsanitary and unsafe method that could have possibly resulted in infection at the site of the mastectomy. In developing countries, women face these decisions every day, wondering how to appear “more beautiful” without breasts or questioning what others will think of them. With high regards to socioeconomic status, men and women try to do everything in order to increase theirs, and this includes lying about mastectomies and reconstruction. It is so important to normalize breast mastectomy survivors and support their decisions for reconstruction.

The studies being conducted in developing countries occur in the more populated, urban cities yet in several case studies, there are holes in the data. This is a prime representation of how, although the studies are being conducted in third world developing countries in their most populated regions, there are still gaps in the statistics. Knowing this, it is clear to say that the data published from case studies are not fully representative of the breast cancer reconstruction rates in the entirety of the country. These data readings may not include rural areas or those that are out of reach or unknown to those conducting the study.

Resources/ Works Cited

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“Breast Reconstruction Options.” American Cancer Society, www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html.
Kothari, Deepak S, et al. “Breast Reconstruction Awareness among Educated Women in a Metropolitan City.” Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India, Medknow Publications & Media Pvt Ltd, Sept. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3580368/.
Sim, Nadia, et al. “Breast Reconstruction Rate and Profile in a Singapore Patient Population: a National University Hospital Experience.” Singapore Medical Journal, Singapore Medical Association, June 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6024220/.
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