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Undergoing breast reconstruction surgery after a mastectomy (removal of the entire breast) is a breast cancer treatment to rebuild the breast using implants or tissue. Research shows that Black patients, specifically Black cis women, are less likely to receive a mastectomy and less likely to receive breast reconstruction after a mastectomy compared to their White counterparts.
Several factors contribute to these disparities, including various barriers to accessing care, a lack of trustworthiness across the healthcare system, and patient beliefs or preferences.
This article provides an overview of mastectomy and breast reconstruction choices among Black patients with breast cancer.
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Choosing Breast Cancer Treatment
Choosing breast cancer treatment is a personal decision you should make with a healthcare provider. Treatment options can include a combination of surgery, radiation, chemotherapy, and more. Research indicates differences in breast cancer treatments that vary by racial/ethnic lines.
Studies have shown that Black women are more likely than White women to choose breast conservation (a lumpectomy, removing a small portion of tissue) over breast removal (mastectomy), even with aggressive subtypes of breast cancer.
Several factors influence this disparity in breast cancer treatment, including:
- Systemic factors: Where a person lives, their income, and if they have any physical or financial barriers to accessing health care services
- Provider factors: Historic mistrust of the medical system combined with healthcare provider bias (conscious and unconscious stereotypes or assumptions about a person or interaction)
- Patient factors: Personal, family, cultural beliefs and preferences, and a person’s perceived risk (how much they worry about a medical issue)
Some studies have noted that Black breast cancer patients have reported feeling less worried than White ones about cancer recurrence and are less likely to believe that mastectomy would have better success rates than other, less-aggressive treatment options.
Data shows that Black patients with breast cancer are less likely to pursue mastectomy of a healthy breast to prevent a recurrence. These racial disparities, in part, are due to the communication people of color have historically experienced with healthcare providers. Black breast cancer patients are less likely to receive adequate information about cancer treatment options.
Barriers to Breast Reconstruction After Mastectomy
After a mastectomy (removal of one or both breasts), some people receive breast reconstruction (surgical reshaping of the breast). Data shows Black patients are less likely to receive reconstruction than White ones, and several studies have examined why.
Similar to the factors that impact Black patients’ lumpectomy or mastectomy choices, experts have identified the following:
- Access to care: Health insurance, medical office locations, and safe, trusted communication with a healthcare provider play a role in the available treatment and reconstruction options. Many studies have found delayed cancer treatment for Black and Latinx patients compared to more prompt treatment for White patients.
- Financial barriers: Statistics show barriers (healthcare costs) influence a patient’s access to breast reconstruction, and equitable care is less prevalent in communities of color.
- Culturally relevant communication: If a healthcare provider cannot communicate with the patient in their preferred language or literacy method, it’s less likely they will be provided with equitable treatment options.
People most likely to receive breast reconstruction identified as White, had higher household incomes, and were covered under private or managed care health insurance plans.
Breast Reconstruction Options
Breast reconstruction after mastectomy can involve implant or tissue reconstruction to reshape the breast.
Implant Reconstruction
Implants are breast-shaped sacs filled with different materials and surgically placed in the chest area to re-create the breast. They’re individually sized based on your preference and are made out of different materials, including:
- Saline (a fluid made of salt and water)
- Silicone (a fluid made of a silicone gel)
- Highly cohesive silicone gel or “gummy bear” implants (a highly cohesive silicone gel that’s more likely to keep its shape)
The type of implant will depend on factors such as the surgical technique used, which implant may work best for your anatomy, and personal preference.
Tissue Reconstruction
Tissue reconstruction involves what’s known as a flap technique. This is when a plastic surgeon uses tissue, skin, and/or fat from other areas of your body for breast reconstruction.
Different flap techniques are based on where and how the surgeon places the incision and performs the procedure, including the TRAM, DIEP, and latissimus dorsi techniques. Another option may be to utilize both implant and tissue reconstruction procedures for the best results.
To advance equitable, patient-centered care, healthcare providers must understand and support the breast reconstruction preferences of patients of color—ensuring all treatment options are available for those who desire to pursue them. Healthcare providers should make the time to discuss resources, referrals, and recommendations for the patient to make a fully informed decision.
Other Breast Cancer Treatment Options
Depending on your situation, healthcare providers may also recommend one or more of the following:
- Chemotherapy: A more aggressive treatment used to attack quick-growing cancer cells
- Immunotherapy: A treatment type that mimics the body’s immune system to fight cancer cells
- Radiation: Use of high-dose energy waves to shrink tumors
- Targeted drug therapy: Medications that directly target cancer cells for specific subtypes of breast cancer
- Surgery (lumpectomy): Surgical removal of a smaller, cancerous portion of the breast
- Hormone therapy: A treatment type that blocks hormones from encouraging breast cancer cells to grow
Researchers are also looking into the role that complementary and alternative medicine (CAM) may be able to play within the breast cancer treatment plan. This includes:
- Mind-body therapies (yoga)
- Biologically based practices (dietary supplements)
- Body-based techniques (massage therapy)
- Whole medicine systems (Ayurvedic medicine, homeopathy)
This field of research is still underway, and there are still many unknowns regarding the effectiveness of these integrative cancer therapies.
Experts have highlighted persistent socioeconomic gaps (a lack of health insurance, transportation challenges, and financial strain) along with delayed treatment start times compared to White patients as issues that have pervaded Black patients’ breast cancer treatment experience.
Summary
Data shows Black patients, specifically Black women, are less likely to receive a mastectomy for breast cancer and also less likely to receive post-mastectomy breast reconstruction than White women. The complex reasons behind these disparities include systemic barriers to care, healthcare provider bias, and patient preference. While breast cancer treatment and reconstruction is an individual choice, researchers recommend focusing more on how healthcare systems can ensure equitable access to these options is available, if desired.
A Word From Verywell
Reviewing your options for breast cancer treatment can feel intimidating and emotional, but you’re not alone. Know that you can ask a healthcare provider for a referral to a social worker specializing in cancer treatment to help you cope. Support organizations like the African American Breast Cancer Alliance (AABCA) and Sisters Network Inc. are available to provide awareness, education, resources, and financial assistance tailored to the Black community.
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