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Factors Driving Low Rates of Post-Mastectomy Breast Reconstruction in Low- and Middle-Income Countries: A Systematic
Ganiat Giwa1, Kowsar Ahmed1, Alexandra J Davis1
1Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Journal of Plastic and Reconstructive Surgery
|June 8, 2026
Summary
Access to post-mastectomy breast reconstruction in low- and middle-income countries (LMICs) is limited by socio-cultural, structural, and financial barriers. Addressing these challenges is crucial for improving breast cancer care and patient outcomes in LMICs.
Area of Science:
- Oncology
- Public Health
- Plastic Surgery
Background:
- Breast cancer is a major health concern in low- and middle-income countries (LMICs), with significantly lower survival rates compared to high-income nations.
- Post-mastectomy breast reconstruction is an integral component of comprehensive cancer care, yet its availability and utilization are notably restricted in LMICs.
Purpose of the Study:
- To systematically review and identify the primary barriers hindering access to post-mastectomy breast reconstruction in LMICs.
- To inform the development of targeted interventions aimed at improving reconstruction rates and patient access in these regions.
Main Methods:
- A systematic literature review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched five databases for peer-reviewed articles published between January 2013 and October 2023, focusing on challenges to post-mastectomy breast reconstruction.
- Extracted and categorized data from 15 eligible studies into socio-cultural, structural, and financial themes using descriptive analysis.
Main Results:
- The review identified intertwined socio-cultural, structural, and financial barriers affecting breast reconstruction in LMICs.
- Key socio-cultural barriers included the perception of reconstruction as cosmetic and fear of anesthesia/recovery.
- Prevalent structural barriers comprised low patient awareness, limited plastic surgeons, concentrated treatment facilities, and low referral rates. Financial constraints, particularly self-payment, emerged as the most significant overall barrier.
Conclusions:
- Post-mastectomy breast reconstruction in LMICs is significantly impeded by a complex interplay of socio-cultural beliefs, structural deficiencies in healthcare systems, and substantial financial limitations.
- Addressing these multifaceted barriers through culturally sensitive education, healthcare system strengthening, and financial support mechanisms is essential to enhance access and patient willingness for reconstruction.