Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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A Qualitative Study of Breast Reconstruction Decision-Making Among Asians
Michelle M. Chang, BS, Rose Fu, MD, Margaret Chen, MD, Christine Rohde, MD, MPH.
Columbia University Medical Center, New York, NY, USA.

PURPOSE: Post-mastectomy breast reconstruction is an important treatment option for women with breast cancer. Despite research supporting psychosocial, emotional, quality of life, and even improved survival benefits, Asian patients are one-fifth as likely as Caucasian patients to pursue reconstruction after mastectomy. Using techniques of grounded theory research, this study investigates the cultural factors, values, and perceptions held by Asian women specific to body image, medical care, surgery, and breast reconstruction that might impact breast reconstruction rates.
METHODS: This qualitative study consists of semi-structured interviews of Asian females who have been treated for breast cancer in New York City. Each interview contained opened-ended questions investigating patients’ social structure, culture, attitudes toward surgery, and body image. Three study investigators independently coded each transcribed interview then collaborated to evaluate recurring themes using an iterative process.
RESULTS: Thirty-five Asian women were interviewed through purposive sampling. The majority of patients were Chinese (83%), with additional Malaysian, Filipino, Korean, and Japanese patients. The mean age was 51 (range: 33-72). Seventeen patients (48.6%) had undergone mastectomy and reconstruction, 13 patients had undergone mastectomy without reconstruction (37.1%), and 5 patients had undergone lumpectomy (14.3%). Initial emerging themes include: functionality, perceptions of plastic surgery, information, and community/family. Patients spoke about breasts as a function of past, current, or future roles as a wife or mother, eliminating the need for breasts when those roles were fulfilled. Many spoke about the fear and inconvenience of multiple surgeries as deterrence to reconstruction. The quality and quantity of information, irrespective of source, and communication with healthcare practitioners greatly impacted perceptions about breast reconstruction and treatment options. Patients often viewed reconstructive surgery not as a treatment option for breast cancer, but as an elective cosmetic procedure. Community and family played a significant role in decision-making scenarios.
CONCLUSION: Asian woman are statistically less likely than their Caucasian counterparts to pursue breast reconstruction for numerous and complex reasons. Having greater access to information regarding treatment options, process, and surgical outcomes may bridge this reconstruction disparity gap. Upon completion of this study, the results will be used to generate a population-based survey to obtain quantitative data. The long-term aim is to equip healthcare professionals to improve breast cancer treatment by increasing breast reconstruction rates in this sub-population.


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