Barriers to access for immediate breast reconstruction: women's voices

Abstract

Introduction: immediate post-mastectomy breast reconstruction is an important component of comprehensive breast cancer treatment. In spite of this, in Colombia, women face several barriers to access this stage of treatment. Objective: to understand the barriers to access to immediate breast reconstruction faced by women and the actions developed to overcome them, based on the voices of the women and the plastic surgeons who attended them. Method: descriptive qualitative research conducted during 2019, involving 13 women reconstructed immediately after mastectomy and residents of the Department of Huila (southern Colombia) and the 4 plastic surgeons of the region. The information was collected through a focus group discussion and 10 semi-structured interviews that were analyzed using the thematic analysis technique. Results: three themes emerged: (i) Administrative barriers to access to immediate breast reconstruction, which describes the denials and delays of authorizations for the surgical procedure; (ii) Legal actions to address barriers to access, account for the participants' obligation to file legal remedies to access care; and (iii) Non-legal actions to address barriers to access, were the individual non-legal actions that women developed parallel to the filing of legal remedies. Conclusions: this is a first qualitative approach that accounts for women's difficulties in accessing immediate breast reconstruction as a result of administrative barriers imposed by insurers; unveiling the urgency of analyzing the structure of the Colombian health system for access to comprehensive breast cancer treatment and of other studies to increase understanding on the subject.