P2-16-13: Life after Mastectomy without Breast Reconstruction – Are the Needs of Caribbean Women Different?
Authors: Morton-Gittens J , Ali R , Affan AM , Bovell P , Rampaul R 
Published: June 2012

Abstract
Aim: The standard of care in the United States and United Kingdom for women undergoing mastectomy is to be offered breast reconstruction surgery (BRS), either immediate or delayed. In Trinidad, for a variety of reasons, patients are not routinely offered this option. We undertook a study to determine the impact of breast surgery without reconstruction on their perception of sexuality, body image, relationships and quality of life. The aim is to establish a benchmark for the planning and incorporation of reconstructive options into the care pathway of patients requiring oncoplastic surgery in the Caribbean.
Method: A questionnaire was administered to post surgery breast cancer patients in a public oncology clinic in Trinidad. These patients had no BRS and had surgery at various institutions in Trinidad, where the primary surgical service was General Surgery. Data was collected prospectively and analysed using SPSS software.
Results: Of 130 questionnaires administered to date, 80(61.5%) of those collected were adequate for analysis. 46.1%(n=35) of patients were less than fifty years of age; 44%(n=24) were Afro-Caribbean and 55.6% (n=30) East Indian-Caribbean; 61.1%(n=44) had mastectomies and 38.9%(n=28) had breast conserving surgery (BCS). Of all patients, 90%(n=70) felt attractive, feminine and satisfied with their bodies before surgery, however postoperatively, all who had BCS remained satisfied with their bodies but a significant proportion of patients in the mastectomy group were dissatisfied(p=0.006) and found it harder to look at themselves naked(p=0.025) and be seen naked by their partners (42.9%, n=15). East Indian-Caribbean women felt less attractive after surgery compared to Afro-Caribbean patients(p=0.024). Among all patients, 19.2% felt shy to go out in public after surgery, 28.8% left their house less and 35% (n=25) had fewer social interactions. When analysed by ethnicity, East Indian-Caribbean women were more likely to avoid public events(p=0.003) and had fewer social interactions(p=0.028) than Afro-Caribbean patients. This effect persisted in mastectomy patients(p=0.007), especially in the East Indian-Caribbean group(p=0.0017). 69% of patients were willing to undergo BRS, but it was offered to only 32.5%(n=13) of mastectomy patients. The interest in BRS was similar in all races, age groups and surgery types.
Conclusion: This study explores the experiences and needs of Caribbean women with breast cancer in Trinidad. We found from this data that their needs mirror those of women in other countries where BRS is incorporated into the core care pathway. Our data demonstrates that even with ethnic differences, there is deterioration in self esteem and feminity with breast cancer surgery, with lasting effects. Subtle differences appear to be present in body image perception amongst East Indian-Caribbean women versus Afro-Caribbean and may be a useful template when assessing patient needs with a view to how we individualize care in the Caribbean setting. This data also emphasizes the potential benefit in incorporating an Oncology-Plastic Surgery Team approach in our setting and supports the view that providing BRS to patients as early as possible can help to maintain a positive outlook in personal and social interactions.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-13.