Breast Reconstruction Practices Among LGBTQ Women

Breast Reconstruction

Breast reconstruction is a surgical process done to rebuild the shape and appearance of a breast and the nipple-areola complex (NAC). Typically, this surgery is preformed on women who have undergone a full or partial mastectomy. The goal of breast reconstruction is to create the illusion of a natural-looking breast through the use of autologous tissue, prosthetic implants, or a combination of both. Reconstruction can typically be done immediately after a mastectomy or preformed later as a secondary surgery depending on a patients needs or preference.

Mastectomy

Surgical Options

Implant reconstruction. The two most common forms of breast implants are saline and silicone. Saline implants are silicon shells containing sterile saltwater (saline) which are filled prior to the implant operation or are filled during the operation. Silicone gel-filled implants are silicone shells that are filled with a plastic gel (silicone) prior to surgery. A benefit shared by both types of implants is a quick recovery time. The downsides to breast implants are that they may need to be replaced after 15-20 years and may have a less natural appearance.

Tissue reconstruction. This procedure involves the removal of skin from one part of the body (typically from the back, thigh or buttock) to use in a reconstruction procedure. The benefits from this technique are that breasts appear more natural-looking and do not require alterations after a desired look is achieved. The downsides to this option are that the recovery time is longer because two sections of the body need to heal, and a follow-up correction surgery is sometimes required.

Demographics

Breast cancer contributes to over 25 percent of the annual cancer cases in North America. An upwards trend in the number of patients diagnosed with breast cancer has been reported since 2012, and the World Health Organization believes the number of cases will continue to rise in coming years. With an increasing number of women diagnosed with breast cancer, it is important to understand why some women choose to get breast reconstruction surgery, and why some choose not to. LGBTQ women are more likely to refrain from breast reconstruction surgery. Roughly 25 percent of LGBTQ women who have undergone some form of breast cancer treatment choose not to undergo reconstructive surgery. Women above the age of 49 also represent a demographic of women who are more likely to refrain from getting breast reconstruction when compared to younger survivors. In all, between 35 to 40 percent of women who are diagnosed with breast cancer require a full mastectomy, but only 25 percent of women undergo immediate breast reconstruction.

Social Implications

External Influences

Feminist scholars have critiqued the heteronormative assumptions that are embedded into the clinical and social treatment of breast cancer survivors. The opportunity to undergo breast reconstruction surgery has shifted from an individual choice, to an expectation that medical professionals assume to be essential in cancer survivorship. Along with this trend, reconstructive surgery following breast cancer surgery has become increasingly normalized and the restoration of breasts are seen as a way to restore 'lost' femininity.

Male-dominated Western societies centre much of men's (hetero)sexual desires around breasts which creates a link between breasts and fetishization/objectification. The appearance of a woman's breasts are often subject to public scrutiny and are often viewed as an indicator of how successful a feminine role is enacted. Breast reconstruction can be seen as a way to recuperate a woman’s lost sense of femininity, by physically restoring a defining feminine feature on a woman- her breasts. In a similar way, plastic surgeons who preform reconstructive surgeries draw from societal expectations of what a healthy body of a woman should look like, aligning with normative ideas of femininity and assume that not-reconstructed breasts make a woman incomplete and physically deformed.

Breast Cancer Ribbon

Pink Ribbon Culture

The 'pinkification' of breast cancer culture meshes the empowerment of women with the celebration of hyper-femininity. Breast cancer culture is grounded in deeply engrained feelings of traditional femininity and gender roles which oppressively demands a surrendering to femininity. This trend has pushed hyper-femininity forward and enabled the popularity of breast reconstructive surgeries to surge in recent years. Pink ribbon culture places breast cancer survivors who fall outside of traditional feminine stereotypes, such as members of the LGBTQ community, at a disadvantage within the breast cancer community.

Outcomes

Breast reconstruction surgery following breast cancer treatments can benefit body image, self-esteem, sexuality, and the overall quality of life for many women. The past two decades of research surrounding breast cancer has illustrated the significant psychosocial benefits for patients who undergo breast reconstruction. A growth in research has shift breast reconstruction surgery to no longer be viewed as a cosmetic surgery, but rather, an operation that is important to total breast cancer recovery. Because of this, breast reconstructive surgeries are covered by all provincial and territorial health care plans in Canada, as well as the majority of American healthcare insurance plans (Medicare and Medicaid). Although the choice to undergo breast reconstruction is a personal decision, it is important to consider the effects that living in a male-dominated Western society has on this decision, as well the overwhelming influence that Western femininity has on the perception of the female body.

Impacts of feminism

Women's Health Movement

The women's health movement (WHM) refers to the feminist movement that works to improve all aspects of women's healthcare. WHM includes improving women's knowledge and control over their own bodies on subjects such as breast cancer and has contributed to changes in the medical approaches to treating women's health. Among these important changes are the legitimization and proliferation of resources for patient self-help, mutual support, and patient advocacy. Prior to the WHM, a breast cancer diagnosis was meant to remain secretive and hidden. Following the WHM, women have gained access to support systems within the survivor community and have been given the opportunity to undergo cosmetic transformations following breast cancer surgeries.

LGBTQ Women

A recent expansion of literature examining LGBTQ women and breast cancer has revealed that LGBTQ women are more at risk for developing breast cancer than heterosexual women. Possible reasons for this include; greater behavioural risk factors (higher alcohol consumption, obesity, avoidance in seeking medical help), and LGBTQ women being less likely to practice breast self examinations. Aside from individual factors, it is important to note the prevalence of discrimination and bias surround sexual minority groups within the healthcare system. LGBTQ patients are more likely to remain quiet about health related issues, despite a heightened risk level for developing breast cancer.

Statistics show that LGBTQ women are less likely to undergo breast reconstruction. Reasons for this are likely that LGBTQ women in general feel less internalized and societal pressure to get reconstruction surgery because the desire to please the male gaze is greatly diminished. Another reason is that our healthcare system favours heterosexual individuals, as subgroups within the LGBTQ community share a common stigmatization as a sexual or gender minority in which limited health research, specifically cancer related, has been done.

Studies

Two studies have been conducted to understand breast reconstruction practices among LGBTQ women. The first study conducted 15 interviews with women who underwent mastectomy’s for breast cancer, with 8 women choosing to get reconstruction and 7 women choosing not to. The study’s results found that LGBTQ women collectively value body strength, survival, and physical functioning over exterior appearance in breast reconstruction decisions. A secondary study yielded similar results when analyzing why LGBTQ women make the decision to get breast reconstruction or not, and found that LGBTQ women resist the hyper and hetero sexualization of breast cancer recovery by making their decision on the individual desire to feel symmetrical and whole. LGBTQ women in both studies shared that their experiences with breast reconstruction related to the desire to no longer appear sick, with no one in the study reporting that their decision was influenced by the need to appear more feminine. These two studies suggest that LGBTQ women are less likely to get breast reconstruction than heterosexual women, however, LGBTQ women who undergo reconstruction make this choice independently, typically in hopes of improving how they physically feel, rather than getting reconstructed in the hopes of appearing more desirable and feminine to society.