Study Suggests Fewer Minority Women Have Reconstruction After Mastectomy Than White Women

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Many, but not all, women who have mastectomy to treat breast cancer go on to have one or both breasts reconstructed. There are many ways to reconstruct a breast. Tissue from the back, belly, buttocks, or other part of the body can be used to create a new breast. Doctors call this autologous reconstruction. Saline or silicone gel implants are another option.

A study published in February 2014 found that more U.S. women were having reconstruction after mastectomy.

A more recent, smaller study suggests that most U.S. women don’t have reconstruction after mastectomy and that minority women are less likely than white women to have reconstruction.

The study was published online on Aug. 20, 2014 by JAMA Surgery. Read the abstract of “Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making.”

The Women’s Health and Cancer Rights Act of 1998 guaranteed insurance coverage for breast reconstruction after mastectomy. While doctors know about breast reconstruction trends in their practices and locations, not much research has been done on national trends.

In this study, the researchers looked at information from Surveillance, Epidemiology, and End Results (SEER) databases for Los Angeles and Detroit. SEER databases are large registries of cancer cases from sources throughout the United States maintained by the National Institutes of Health.

From the SEER databases, the researchers selected a sample of 3,252 women aged 20 to 79 who had been diagnosed with DCIS or stage I-III invasive breast cancer. The researchers made sure that black and Latina women were appropriately represented in the sample.

About 9 months after being diagnosed, all the women were sent a survey that asked about:

  • the type of breast cancer surgery they had
  • the type of reconstruction they chose (if any)
  • the reasons they chose reconstruction or not
  • their attitudes toward reconstruction

The women were able to answer the survey in English or in Spanish.

Nearly 2,300 women completed the survey; women who were breast cancer-free 4 years later were sent a second survey that asked about immediate versus delayed reconstruction and more questions about their attitudes toward reconstruction. More than 1,530 women completed the second survey. Of these women, 485 had had a mastectomy and the researchers analyzed their answers for this study.

The researchers found:

  • 24.8% of the women had immediate breast reconstruction
  • 16.8% had delayed reconstruction

This means that only 41.6% of the women had reconstruction.

Immediate reconstruction is done at the same time as mastectomy surgery. As soon as the breast is removed by the breast cancer surgeon, the plastic surgeon reconstructs the breast either with tissue from another location on your body or with an implant (and sometimes both). Nearly all the work is done during one operation.

Delayed reconstruction is done after mastectomy surgery, as well as after radiation therapy, chemotherapy, or targeted therapies. Treatments such as radiation therapy and sometimes chemotherapy given after surgery can cause the reconstructed breast to lose volume and change color, texture, and appearance. Radiation therapy in particular is known to cause undesirable changes to a reconstructed breast. Research also has shown that a reconstructed breast may interfere with radiation therapy reaching the area affected by cancer. Many surgeons advise patients to wait until after radiation and chemotherapy are finished before having reconstruction. This means reconstruction might be done 6 to 12 months after mastectomy.

Women who were:

  • black
  • less educated
  • older
  • diagnosed with another serious illness
  • being treated with chemotherapy

were less likely to have reconstruction.

Only 13.3% of the women were unhappy with the reconstruction decision-making process they went through. Still, more minority women were unhappy with the process than white women.

The most common reasons the women gave for not having reconstruction were:

  • wanting to avoid more surgery
  • feeling that reconstruction wasn’t important
  • fear of breast implants
  • fear that reconstruction would interfere with detecting cancer later

Few women (30 of 263) who didn’t have reconstruction were still considering it more than 4 years after being diagnosed.

"Our study suggests that room exists for improved education regarding the safety of breast implants and the effect of reconstruction on follow-up surveillance, information about which could be readily addressed through decision tools,” the researcher wrote. “Development of specific approaches to address patient-level and systems factors with a negative effect on the use of reconstruction among minority women is needed."

Deciding whether to have a breast reconstructed after surgery to remove breast cancer is a very personal choice. If you’ve been diagnosed with breast cancer and are planning your surgery, you may decide not to have reconstruction, but it can be helpful to consider all your options.

Here are some questions you might want to think about as you're making your decision about breast reconstruction:

  • Is it important to you to have a permanent breast shape? Some women prefer to wear a prosthesis instead of having reconstruction.
  • Is it important to you that your breasts look balanced when wearing a bra and bathing suits? Though you'll be able to see the difference between the rebuilt breast and your other breast when you're naked, reconstruction usually looks very natural when you're wearing a bra or bathing suit.
  • In your unique situation, will breast reconstruction involve several surgeries over a long period of time? For many women, the answer is yes.
  • Will your insurance pay for all the reconstruction procedures? Find out what your insurance company will cover.
  • Did you have a lumpectomy that gave your breast a very different shape than it originally had? If you had a large portion of tissue removed, you might want to have reconstruction to restore a more balanced look.
  • Do you have any other medical conditions that might affect your ability to heal after surgery? If you have diabetes, circulatory problems, or a bleeding disorder, it may take your body longer to heal from reconstruction surgery than someone who doesn't have these conditions.
  • Do you have a condition that might give you a distorted image of your body? If you've been diagnosed with anorexia or bulimia, you may have a hard time accepting how your body looks in general, which may make it hard to accept how your reconstructed breast looks.

For more information, including types of reconstruction and the timing of reconstruction, visit the Breastcancer.org Breast Reconstruction section.


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