Living Flat: Stories from Women of Color After Mastectomy

Jasmine A Khubchandani; Sakinah C Suttiratana; Rosetta Washington; Dawn White-Bracey; Madhav Kc; Andrea Silber; Oluwadamilola M Fayanju; Paris D Butler; Alka Menon; Rachel A Greenup

doi:10.1245/s10434-024-16337-y

Living Flat: Stories from Women of Color After Mastectomy

Ann Surg Oncol. 2024 Oct 15. doi: 10.1245/s10434-024-16337-y. Online ahead of print.

Authors

Jasmine A Khubchandani^{1

2

3}, Sakinah C Suttiratana⁴, Rosetta Washington⁴, Dawn White-Bracey⁴, Madhav Kc⁵, Andrea Silber⁴, Oluwadamilola M Fayanju⁶, Paris D Butler⁷, Alka Menon⁸, Rachel A Greenup^{5

7}

Affiliations

¹ National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA. jasminekhubchandani@gmail.com.
² Veterans Affairs Connecticut Healthcare System and Yale University, West Haven, CT, USA. jasminekhubchandani@gmail.com.
³ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. jasminekhubchandani@gmail.com.
⁴ Center for Community Engagement and Health Equity, Yale Cancer Center, Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA.
⁵ Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.
⁶ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
⁸ Department of Sociology, Yale University, New Haven, CT, USA.

PMID: 39407064
DOI: 10.1245/s10434-024-16337-y

Abstract

Background: There remain persistent racial and ethnic disparities in the receipt of post-mastectomy breast reconstruction for breast cancer. Yet, patient-reported outcomes and advocacy efforts around living flat overwhelmingly have focused on white women. We sought to characterize the lived experiences among women of color living flat after mastectomy for breast cancer.

Patients and methods: Our community-partnered study included a sociodemographic and health questionnaire followed by semistructured interviews. Using an interview guide designed in an interdisciplinary manner, we explored themes related to culture and community after mastectomy. Women ≥ 18 years old who underwent mastectomy without reconstruction for breast cancer were included. Interviews were performed by formally trained community-based research fellows and conducted virtually over video conferencing, recorded, and transcribed. Data were analyzed on NVivo using an integrated (inductive and deductive) team-based approach.

Results: The final cohort included 20 women, 60% identified as Black, 20% as Asian, 10% as multiracial, 5% as Latina, and 5% as white. Key concepts included: (a) cancer stigma, (b) privacy around breasts, (c) finding support through shared experiences, (d) sacrifice of breast for life/health, (e) spirituality, (f) patients' familial roles and relationship to breast, and (g) societal expectations. Women described the intersection of cancer stigma and privacy around breasts influencing knowledge of family history and support during cancer treatment.

Conclusion: Among women of color, breast cancer stigma and spirituality are key contributors to quality of life after mastectomy without breast reconstruction, domains not routinely included in contemporary patient-reported outcome measures. Representation of diverse experiences is critical to achieving equity.

Keywords: Breast cancer; Community-based participatory research; Culture; Going flat; Health equity; Living flat; Mastectomy without reconstruction; Surgical amastia.

Abstract

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