Perception of Breast Reconstruction among 10,299 Indian Women

Abstract

Background: Less than 1% of women undergo breast reconstruction after mastectomy in India. To understand if the perception of breast reconstruction among Indian women is a contributing factor, a survey of 10,299 women was done. Method: In total, 10,299 women answered questions from a questionnaire with the help of social workers (10,005) and using the Surveymonkey App (294). Results: An estimated 48.8% of women were aware of breast reconstruction. Around 77.5% felt that women would feel depressed after mastectomy, and 76.5% said they would prefer breast reconstruction. Irrespective of age and financial status, most women preferred breast reconstruction after mastectomy. Autologous reconstruction (79.6%) was preferred to implant reconstruction (20.4%). An estimated 71.3% liked the idea of a DIEP flap. When explained that DIEP flap may take 6–8 hours of surgery and cost about US $3500, only 48.8% would go for a DIEP flap. For early breast cancers, women preferred breast conservation surgery (65.7%) to mastectomy and breast reconstruction (34.3%). Women felt that the best way to increase awareness of breast reconstruction would be by social media (47.8%) followed by word of mouth (16.4%), television (13.4%), newspapers (11.7%), and magazines (10.6%). Conclusions: Although the breast reconstruction rates are very low, women preferred breast reconstruction to mastectomy alone regardless of age and financial status. The surgical teams should devise strategies to assure woman that they can achieve reliable reconstruction at an affordable cost. Increasing experience and reduction of operation time would make autologous breast reconstruction affordable. This strategy could apply to most developing economies.

Rates of breast reconstruction uptake and attitudes toward breast cancer and survivorship among south asians: A literature review

“…Though rates of reconstruction are low in South Asian countries, when surveyed, patients expressed concern about their aesthetic appearance following breast cancer treatment. 77.5% 38 of women felt that they would be depressed after mastectomy and post‐surgery, many patients voiced a tendency to avoid looking at their bodies in the mirror. One participant reported that she felt “self‐conscious” and “disfigurish” even after over 20 years of the illness 6 .…”

“…There is an incorrect notion amongst patients that reconstructive procedures are only available in countries outside of South Asia. Many South Asian patients report feelings of selfconsciousness and dissatisfaction about their bodies following mastectomy procedures 6,8,38 and would benefit from increased awareness of reconstructive options available within their countries.…”

“…When the deep inferior epigastric artery (DIEP) flap was introduced to a group of 10,299 women in India, 71.3% were open to reconstruction via DIEP flap but after further explanation of the cost (US $3500) and length of the surgery (6-8 h), that number dropped to 48.8%. 38 Respondents described the procedure as "too long [and] too expensive" and expressed doubts about whether a good reconstruction could be done. 38 Access to healthcare services in general is financially taxing for many South Asian people.…”

“…38 Respondents described the procedure as "too long [and] too expensive" and expressed doubts about whether a good reconstruction could be done. 38 Access to healthcare services in general is financially taxing for many South Asian people. Per World Bank data from 2020, 39 healthcare spending is mostly out of pocket (OOP) for most South Asian countries with 53% of all healthcare spending in India being OOP, a high of 74% in Bangladesh, 55% in Pakistan, 58% in Nepal, 49% in Sri Lanka, and Bhutan at a low of 15%.…”

Postmastectomy Breast Reconstruction: An Exigent Need for the Impetus

“…However, more than 75% of women in India prefer reconstruction if offered. 8 Affordability of additional cost is a significant hurdle for reconstructive procedures. Unfortunately, health insurances consider this a cosmetic procedure.…”