Living Flat: Study sheds light on challenges for women of color after breast cancer surgery

Yale Cancer Center researchers at Yale School of Medicine have taken a significant step towards understanding the unique experiences of women of color living flat without breast reconstruction after a mastectomy (surgery). Their new study titled, "Living Flat: Stories from Women of Color After Mastectomy," published in Annals of Surgical Oncology on October 15, explains how cultural factors, spirituality, and personal beliefs play an important role in the lives of women of color after mastectomies.

In the paper, the authors say that “persistent racial and ethnic disparities remain in receipt of post-mastectomy breast reconstruction for breast cancer.” Historically, patient-reported outcomes and advocacy efforts around “living flat” overwhelmingly have focused on white women. The study aimed to better understand the personal outcomes and support systems for women of color. The research involved women aged 18 and older who had undergone a mastectomy without breast reconstruction. Through a carefully designed interview process- including engagement from community members as part of the research team- and detailed questionnaires, the researchers gathered data on the sociodemographic and health backgrounds of the participants. The study involved 20 women, with the majority identifying as Black (60%), followed by Asian (20%), multiracial (10%), Latina (5%), and white (5%).

The findings highlighted several key elements that were discussed by the study participants, including cancer stigma, breast privacy concerns, the importance of support through shared experiences, the sacrifice of breasts for life and health, the role of spirituality, the impact on family relationships, and societal expectations. Researchers say cancer stigma and privacy concerns were of particular interest- many study participants reported that cultural norms prevented discussion of cancer as well as women’s health which affected women's knowledge of their family history, personal breast cancer risk, and the support they received during treatment. The study also found that spirituality was a significant factor influencing the quality of life for women of color after their mastectomy. 

“Our team-based approach allowed us to learn from women of color regarding their rich experiences with living flat after mastectomy," said the study’s senior author Dr. Rachel Greenup, section chief of breast surgery in Yale’s department of surgery and co-director of the Center for Breast Cancer at Yale Cancer Center and Smilow Cancer Hospital. "These untold stories identified key aspects of the breast cancer journey that are not routinely addressed in shared decision-making nor included in validated outcome measures. Inclusive patient-centered cancer care must address physical, emotional, sociodemographic and cultural well-being.”

The research highlights the importance of acknowledging the diverse experiences and spirituality of women of color in mastectomy discussions, so healthcare providers and support networks can offer more inclusive and effective care. This study also calls for greater equity in patient-reported outcomes and a broader recognition of personal and cultural factors contributing to the well-being of women of color after breast cancer surgery.

Jasmine Khubchandani, chief surgery resident at Massachusetts General Hospital and a scholar in the National Clinician Scholars Program at Yale School of Medicine, joined Greenup as first author. Other authors included Sakinah Suttiratana, Rosetta Washington, Dawn White-Bracey, Oluwadamilola Fayanju, Madhav Kc, Andrea Silber, Paris Butler, and Alka Menon. The research was funded by the Department of Surgery at Yale School of Medicine.