Patients' Perspectives on Breast Reconstruction in Sub-Saharan Africa.

Importance: Mastectomy hesitation among women with breast cancer in sub-Saharan Africa contributes to late presentation, advanced disease, and high mortality rates in the region. Mastectomy alone has been found to substantially reduce quality of life among sub-Saharan African women. Breast reconstruction may improve quality-of-life sequelae from mastectomy, as well as improve the acceptance of oncologic surgical treatment. Little is known about women's attitudes and perceptions about breast reconstruction in the African context. Objective: To explore sociocultural perspectives, attitudes, and perceptions on breast reconstruction among female patients with breast cancer in sub-Saharan Africa. Design, Setting, and Participants: This qualitative study of patients with breast cancer was conducted in December 2023 and February 2024. Content analysis was performed from February 2 to June 27, 2024. Two large urban academic hospitals, Komfo Anokye Teaching Hospital and St Paul's Hospital Millennium Medical College, identified eligible patients during visits to breast cancer clinics. Main Outcomes and Measures: Perspectives, attitudes, and perceptions on breast reconstruction were obtained using semi-structured interviews with patients with breast cancer. Results: A total of 46 women were interviewed, 25 in Ghana (mean [SD] age, 46.1 [8.9] years) and 21 in Ethiopia (mean [SD] age, 48.7 [8.3] years). Three major themes were identified. First, women's perceptions toward breast reconstruction were shaped by a balance of breasts contributing to self-identify vs breasts serving only a functional purpose. Second, attitudes were influenced by the life stage of a woman, such that reconstruction was viewed as beneficial for younger, dating women, but benefits decreased as women age. Third, opinions on breast reconstruction varied between perceiving reconstruction as natural or as contradicting divine will. Conclusions and Relevance: In this qualitative study of women with breast cancer in Ghana and Ethiopia, there was a complex interplay of factors associated with shaping these women's perspectives toward breast reconstruction. These findings provide insights that may aid in the development of tailored interventions specific to women in sub-Saharan Africa. Such interventions may have implications for improved patient-centered counseling, quality of life, and holistic breast cancer care.