At 57, Raima (name changed) had thought her battle with breast cancer was about getting through treatment while also coping with the loss of a breast and concerns about her body image and confidence.
However, the idea of breast reconstruction came up only when her two adult daughters urged her to consider her own needs, including restoring her sense of self-worth.
In another Delhi family, a widow in her late sixties found the confidence to explore the procedure with the support of her two sons.
“Their choices stand in contrast to the experience of many Indian women, for whom life after mastectomy can mean coping not only with the loss of a breast but also with concerns about body image, confidence and the cost of further surgery,” pointed out Dr Shikha Gupta, Senior Consultant, Plastic and Reconstructive Surgery, Amrita Hospital, Faridabad.
Both women had undergone breast reconstruction under Dr Gupta’s observation.
Reconstruction, she said, is increasingly being considered not just in terms of appearance but also its potential contribution to body image and quality of life. But in most cases, these patients come forward when they get family support, like happened in these two cited cases, she said.
“Breast reconstruction is a safe procedure and does not increase the risk of breast cancer recurrence or affect the detection of recurrence,” Dr Gupta added.
The risks and benefits, however, need to be discussed with each patient in the context of her treatment, she emphasised.
Dr Shivangi Saha, Assistant Professor, Plastic, Reconstructive and Burn Surgery, AIIMS, Delhi, agreed as she noted, "Advances in surgery have expanded the available options. Techniques include the use of implants or tissue from a woman’s own body, with detailed planning and microsurgery in selected cases. Newer approaches also aim to restore sensation, although results can vary.
“Over the past decade, plastic microsurgical techniques have advanced significantly in India. Today, we have experienced surgeons and well-trained teams across the country who can offer safe and reliable breast reconstruction,” she said.
“I strongly feel that every woman undergoing breast cancer surgery should be informed about the possibility of breast reconstruction, whether at the time of cancer surgery or later. It may not be the choice for everyone, but every woman deserves to know her options and make an informed decision.”
Yet reconstruction remains out of reach for many, as has been found in a study published in the latest edition of the journal Annals of Breast Surgery.
Financial worries, fear that reconstruction could delay cancer treatment and limited access to specialist surgeons are keeping many Indian women from considering breast reconstruction after mastectomy, said the survey based on the observation of 64 surgeons in the sector.
The median proportion of patients undergoing immediate breast reconstruction reported by surgeons was 18%, while delayed reconstruction accounted for 4%. The median overall rate was 22%, with wide differences between practice settings.
The findings also highlighted a gap in breast cancer care. While treatment focuses on removing the disease, women may have limited opportunities to discuss options that could help them regain confidence and adjust to life after surgery.
About 81% of surveyed surgeons identified cost as a reason patients declined reconstruction. Nearly 66% cited fear of cancer recurrence or treatment delays, while half said family disapproval influenced decisions.
“These concerns show that the decision is not always about whether a woman wants reconstruction. Sometimes, she may not be able to afford it, may fear further treatment or may not receive enough support to explore the option,” said Dr Samarth Gupta, lead author of the study and Senior Consultant, Plastic, Reconstructive and Aesthetic Breast Surgeon at Apollo Athenaa Women’s Cancer Centre, Delhi.
Access to specialist care also varied. Only 39.1% of respondents said plastic surgery services were available at their main practice site. Nearly half relied on referrals, while 12.5% reported having no such services.
The median immediate reconstruction rate was 21% at centres with on-site plastic surgeons, compared with 17% at centres relying on referrals and just 1% where services were unavailable. The reported rate was also lower in semi-urban and comparatively resource-constrained settings than in metropolitan tertiary centres.
Dr Abhishek Raj Alagarasan, Plastic and Reconstructive Surgery Unit, Clarité Hospital, Madurai, and co-author of the study, however, cautioned that these figures were based on surgeons’ estimates and do not prove that specialist availability alone determines access. Affordability, hospital resources, referral arrangements and patient preferences may also play a role.
Dr Venkat Ramakrishnan, Plastic and Reconstructive Surgeon at Chennai Breast Centre, and also co-author of the study emphasised that the emotional impact of losing a breast deserves greater attention.
Dr Ramakrishnan was of the opinion that these concerns need to be addressed through clear medical advice. The suitability and timing of reconstruction depend on the individual’s cancer, overall health and treatment plan. The other authors of the study were Dr Geeta Kadayaprath and Dr Preeti Grewal.
The survey also found that 70.3% of surgeons said plastic or reconstructive surgeons were not routinely included in multidisciplinary cancer team discussions at their main practice sites. Joint breast reconstruction clinics were identified as a possible solution by 84.4% of respondents.
Dr Samarth Gupta called for closer coordination between cancer surgeons and reconstructive specialists who could help women understand their options early, rather than having to seek information and referrals on their own.
“Regional referral networks could also help patients treated at hospitals without reconstructive services,” he said.
His views about the need for better counselling are underscored by an earlier study of 10,299 Indian women, published in Plastic and Reconstructive Surgery – Global Open in 2021. It found that 76.5% preferred breast reconstruction, but only 48.8% knew it was available.
