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Heterosexist biases affect breast reconstruction decision among lesbian breast cancer patients, study finds

A study that explored lesbian breast cancer survivors’ attitudes toward breast reconstruction found that the pressure by social norms is among the key considerations when undergoing reconstructive surgery.

After noting how lesbian-identified women think about breast reconstruction after having breast cancer (BC), a  study that explored lesbian BC survivors’ attitudes toward breast reconstruction found that the pressure by social norms is among the key considerations when undergoing reconstructive surgery.

In “Rejection of Breast Reconstruction Among Lesbian Breast Cancer Patients” in LGBT Health, Rachael L. Wandrey, MS; Whitney D. Qualls, BA; and Katie E. Mosack, PhD noted that after having BC and being treated by mastectomy, patients typically struggle with decisions about reconstruction. But existing body of knowledge tend to highlight the plight of lesbian women; thus this study.

For this study, the authors conducted an inductive thematic analysis of breast reconstruction discussions among individuals who posted to a lesbian-specific online support forum found on breastcancer.org, an online support venue for BC survivors. Two hundred fifty-five users posted to the lesbian-specific forum; 53 of these users discussed breast reconstruction and were included in the present analysis. The authors analyzed a total of 168 posts.

The study found five “themes” related to breast reconstruction attitudes as follows: (1) rejecting being defined by their body image, (2) privileging sensation over appearance, (3) believing that being breastless is protective, (4) perceiving their social context as supportive of nonreconstruction, and (5) feeling pressured by social norms to undergo reconstructive surgery.

“Among postings in the lesbian-specific online support forum, attitudes related to the rejection of breast reconstruction were pervasive. Provider communication should be evaluated for heterosexist biases, such as the implication that breast reconstruction should be a part of a normal course of treatment. In addition, providers must acknowledge that breast reconstruction is value laden and the range of viable treatment and construction options, including the decision not to reconstruct, should be presented in a nonbiased neutral way,” the authors stated.

It was earlier noted that “sexual minority women (SMW) are at significantly greater risk for developing BC than their heterosexual counterparts. Emerging evidence suggests that lesbians and bisexual women are at an increased risk for BC not because of their sexual orientation, per se, but because some risk factors and barriers to screening are more prevalent in this population (e.g., lack of birth control use, greater prevalence of obesity).”

Indeed, “researchers using the Rosner-Colditz risk prediction model, which quantifies reproductive risk factors for BC, have found that SMW are at greater risk for BC compared with heterosexual women (HW) throughout the premenopausal period. Higher rates of BC mortality among women who cohabit with same-sex partners have also been reported.”

Some researchers also suggest that “SMW (and lesbians, in particular) experience BC differently than HW. For example, lesbians have reported higher stress related to diagnosis and treatment, lower satisfaction with care delivered by physicians, and more problems with chemotherapy-induced side effects than their heterosexual counterparts.”

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The authors recommended that in delivering patient care, “oncologists have a responsibility to recognize that breast reconstruction is value laden. They should examine their biases and present multiple treatment options, including those that do not involve reconstructive breast surgery.”

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