Summary: American Indian/Alaska Native women with breast cancer are significantly less likely to undergo breast reconstruction after mastectomy compared to non-Hispanic White women, despite an overall increase in reconstruction rates.

Key Takeaways:

  1. Ongoing Disparity in Reconstruction Rates: American Indian/Alaska Native (AI/AN) women still have significantly lower breast reconstruction rates after mastectomy compared to non-Hispanic White women, despite overall increases.
  2. Impact of Socioeconomic and Health Factors: Higher comorbidity, prevalent public insurance, and lower educational levels in AI/AN women contribute to their lower reconstruction rates, alongside systemic healthcare biases and funding issues.
  3. Importance of Tailored Care: Enhancing care through multidisciplinary approaches and understanding AI/AN women’s views on breast cancer care can improve decision-making and empower AI/AN women regarding reconstruction choices.


American Indian/Alaska Native (AI/AN) women with breast cancer have consistently lower rates of breast reconstruction after mastectomy compared to non-Hispanic White women, reports a paper in the July issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Despite an upward trend in reconstruction, AI/AN women continue to be less likely to undergo breast reconstruction,” comments Jane Hui, MD, MS, of the University of Minnesota in Minneapolis. “While our findings point to some possible approaches to reducing this disparity, it will be essential to also determine Native women’s opinions related to breast reconstruction.”

Factors Affecting Breast Reconstruction in AI/AN Women

Using data from the National Cancer Database, the researchers identified 1,980 AI/AN women and 414,036 non-Hispanic White women who underwent mastectomy for breast cancer between 2004 and 2017. Annual breast reconstruction rates were compared between groups, along with factors associated with decisions about reconstruction.

The two groups differed in some important characteristics. American Indian/Alaska Native women had higher rates of other medical diagnoses (comorbidity), 20% versus 12%; were more likely to have public health insurance, 49% versus 20%; and more likely to undergo single-breast (unilateral) mastectomy.

Over the 13-year study period, breast reconstruction increased in both groups: from 13% to 47% for AI/AN women and from 29% to 62% from non-Hispanic White women. After adjustment for other factors, AI/AN women remained nearly one-half less likely to undergo reconstruction.

Other factors associated with lower reconstruction rates included older age, earlier year of diagnosis, more advanced cancer, unilateral mastectomy, public insurance and living in an area of lower educational attainment. Within the AI/AN group, reconstruction was more likely for younger women; those with more recent diagnosis, less advanced cancer, and less comorbidity; and those living in urban areas or areas with a higher level of educational attainment.

Addressing Breast Reconstruction Disparities in Native Women

Breast reconstruction after mastectomy has known benefits for some, including improved quality of life and body image. However, breast reconstruction is a personal decision—there is “no optimal proportion“ of patients who should opt for reconstruction, Hui and her colleagues note.

American Indian/Alaska Native women face a wide range of health disparities and barriers to medical care, including elevated rates of chronic health conditions, later diagnosis, and higher mortality from breast cancer. “Complicating the healthcare environment in which AI/AN receive medical care is chronic underfunding of the Indian Health Service (IHS), implicit bias against AI/AN and fraught relationships between physicians and AI/AN patients,” the researchers write.

Their study offers insights into factors associated with the lower rate of breast reconstruction for AI/AN women with breast cancer.

“Multidisciplinary efforts to improve care delivery to AI/AN women may continue to minimize disparities through earlier diagnosis and treatment,” Hui and her coauthors conclude. “Simultaneously, qualitative research into AI/AN perspectives on breast cancer care could improve shared decision-making between physicians and AI/AN patients, empowering AI/AN women to choose post-mastectomy reconstruction if they so desire.”