Perceptions of Breast Reconstruction Among Native American Women: A Qualitative Analysis

Abstract

Abstract Background Despite having a high incidence of breast cancer, Native American/American Indian (NA/AI) women have among the lowest rates of breast reconstruction (BR). While NA/AI women are often racially miscategorized, little is known as to why reconstruction rates remain low. This study investigates cultural factors, values, and perceptions of held by NA/AI that might impact BR rates. Methods Individual, semi-structured interviews utilizing open-ended questions prompting for insight into barriers to care, cultural values, body image, and reconstructive preferences were conducted. All interviews were audio-recorded and transcribed. Qualitative content analysis was performed, which allowed for inductive themes to be drawn from the raw data. Results Fifteen NA/AI women who underwent surgical treatment for breast cancer were interviewed. Emerging themes included acceptance, privacy, humility, wholeness, self-image, negative perceptions of plastic surgery, naturality, fear, and cultural contraindication of ADM use. All women discussed their reconstructive options with a breast surgeon, but only 3 chose to reconstruct. Most women suggested that reconstruction with autologous tissue was a more culturally congruent choice than implant-based reconstruction. Reconstructive surgery was often viewed as strictly cosmetic. All women unanimously opposed ADM use in BR due to cultural beliefs surrounding the use of tissue from deceased individuals. Conclusions This is the first study to investigate culture-specific perceptions of BR. Our results suggest that culture specific factors and preferences may contribute to low rates of BR. Results from this study can be used to improve cultural competency in addressing BR in NA/AI women.