“Who Am I Trying to Fool, God or Myself?”: A Qualitative Analysis of Sociocultural Attitudes and Perceptions about Breast Reconstruction in Sub-Saharan Africa

OBJECTIVE: Qualitatively explore knowledge about breast reconstruction and barriers to reconstruction among sub-Saharan Africa (SSA) women. METHODS: We designed an interpretive description, a noncategorical qualitative method suited for applied healthcare research to address our question. 45 women (20 from Ethiopia, 25 from Ghana), with a diagnosis or history of breast cancer (Stage 0-III) were recruited at St. Paul's Hospital in Ethiopia and Komfo Anokye Teaching Hospital in Ghana. Semi-structured in-person interviews were conducted in English, Amharic, or Twi. Utilizing MaxQDA, narratives were inductively analyzed in a team based iterative approach. RESULTS: Three key themes emerged. 1) Women viewed their bodies through a lens of utility versus aesthetics. While initially seeing breasts as functional, they recognized the emotional impact of mastectomy and believed breast reconstruction could restore their self-image and confidence. 2) Age and life stage influenced perceptions of reconstruction's appropriateness, with younger women, particularly those seeking a partner, seen as benefiting more from social aspects of reconstruction. 3) High costs and limited access to healthcare fostered reluctance towards using medical services, with fears of potential complications and escalating costs deterring further engagement. A lack of awareness about breast reconstruction also shaped initial reactions. CONCLUSION: As the plastic surgery community intensifies efforts to enhance global surgical capacity, providers are urged to carefully consider the complexities of the current breast cancer treatment landscape. Effective strategies to serve this population should include patient education and a deeper understanding of the culturally held beliefs about bodies, disease, and prevailing healthcare inequalities. CORRESPONDING AUTHOR: Natalie Guzman, 1301 Catherine St, Ann Arbor, MI 48109, [email protected], 513-417-0879