title: 'Use what God has given me': difference and disparity in breast reconstruction.
abstract: African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use 'what God has given'. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients' skin tones. We suggest that a framework of 'stratified biomedicalization' better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.
authors.affiliation: a Department of Psychology , The New School for Social Research , New York , NY , USA .
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Rubin
authors.forename: Jessica
authors.initials: J
authors.lastname: Chavez
authors.forename: Amy
authors.initials: A
authors.lastname: Alderman
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D001828:Body Image / Q000523:psychology; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery; D002755:Choice Behavior; D003466:Cultural Characteristics; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D016462:Mammaplasty / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City; D036301:Qualitative Research; D012068:Religion and Medicine; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
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