Breast cancer is now the most common cancer among Indian women. While advances in treatment have improved survival, the emotional and psychological impact of mastectomy is often overlooked, with fewer than 1 per cent of women in India receiving breast reconstruction, compared to over 65 per cent in the West. Dr Venkat Ramakrishnan, Senior Consultant, Plastic Reconstructive Surgeon of Chennai Breast Centre, speaks with THE WEEK on why breast reconstruction is important for women who undergo mastectomy.
Do you think breast reconstruction is important for women who undergo mastectomy? Why is that most Indian women do not go for it?
Breast cancer is the most prevalent cancer among women in India, accounting for more than a quarter of all female cancer cases. According to the Global Cancer Observatory, India reported nearly two lakh new cases of breast cancer among women in 2022. Primarily due to late diagnosis, about 60 per cent of the cancer patients require a mastectomy, involving the complete removal of the breast.
A prosthesis is hardly a real solution. Women may use it inside their bra in public, but there is always the fear that it could slip or shift, exposing the deformity. This worry accompanies them to the gym, the swimming pool, and social events. Over time, they learn to navigate these challenges, choosing clothes with care and planning their activities thoughtfully, essentially embracing a paradoxical lifestyle modification. And all of this is quietly accepted as the “price of survival”.
However, breast reconstruction after mastectomy can transform this experience for the better. It offers several well-established benefits for a woman’s emotional and psychosocial well-being. It is a surgical procedure that restores the shape of the breast following its removal.
How common is breast reconstruction in India compared to other countries?
There is a prevailing concern that requesting breast reconstruction may be dismissed as a frivolous or purely cosmetic demand. The common attitude is that since the deformity can be concealed with a prosthesis, reconstruction is unnecessary. In the process, the feelings of a woman who is acutely aware of her deformity are rarely given due consideration. In reality, breast reconstruction is about correcting a deformity and restoring wholeness, not about cosmetics, but about alleviating the profound emotional and psychological burden that accompanies breast loss.
Such entrenched mindsets, coupled with poor awareness, limited access, financial constraints, and fear of surgery, mean that a vast majority of women do not avail themselves of the benefits of breast reconstruction. Barely 0.5 pc of women in India undergo the procedure, compared with over 65 pc in the West, including Europe, the UK, the US, Australia and Canada.
What are the modern breast reconstruction techniques available these days?
Several reconstruction options exist, broadly falling into two categories: implant-based reconstruction, and reconstruction using tissue or fat from other parts of the woman’s own body.
Tissue-based breast reconstruction methods have progressed enormously over the years. A few decades ago, the goal was simply to create a mound to fill the bra, often bearing little resemblance to the natural breast. It was essentially seen as a cosmetic filler rather than a true reconstruction.
Today, with modern microsurgical techniques, surgeons use fat from the lower tummy to create a breast that looks and feels natural. An effective technique, known as Deep Inferior Epigastric Perforator (DIEP) flap, is considered the gold standard for breast reconstruction, provided enough tissue is available.
In this technique, fat is taken from the abdomen while preserving the abdominal muscles, making it one of the most advanced and safest forms of reconstruction. DIEP flap provides a natural-looking and feeling breast, which ages with the patient and fluctuates in weight as a normal breast would. An added advantage is that removing excess abdominal fat can improve overall health while giving the patient a flatter tummy.
Is breast reconstruction safe, and does it interfere with cancer treatment?
Another common concern is that reconstruction might hide a recurrence of breast cancer. In reality, proper treatment of stage 1, 2, and many stage 3 cancers with mastectomy eliminates the chances of local recurrence. Reconstruction does not interfere with cancer treatment.
Radiotherapy and chemotherapy proceed as usual, and it does not hinder follow-up examinations or the patient’s return to normal activities. There is also a prevailing concern that requesting breast reconstruction may be dismissed as a frivolous or purely cosmetic demand. The common attitude is that since the deformity can be concealed with a prosthesis, reconstruction is unnecessary. In the process, the feelings of a woman who is acutely aware of her deformity are rarely given due consideration. In reality, breast reconstruction is about correcting a deformity and restoring wholeness, not about cosmetics, but about alleviating the profound emotional and psychological burden that accompanies breast loss.
What changes are needed in India to improve the uptake of breast reconstruction?
The need for greater awareness about breast reconstruction is urgent. With a clearer understanding of its benefits, more women can make informed choices and see reconstruction as an integral part of complete recovery. As awareness and demand increase, the availability of specialised expertise in breast cancer care and reconstruction will naturally expand.
The way forward is to integrate breast reconstruction into cancer care, ensuring that women receive truly comprehensive support from diagnosis to recovery. Every patient scheduled for a mastectomy should be informed about reconstruction options, even if not all ultimately choose the procedure. In many Western countries, women recommended for mastectomy are routinely offered immediate reconstruction; in India, this crucial step is often overlooked.
Achieving this integration also requires expanding the pool of skilled professionals through focused training for oncosurgeons and reconstructive specialists. India needs dedicated breast oncosurgeons and plastic surgeons who specialise in breast reconstruction. For comparison, the UK has roughly one dedicated breast reconstructive plastic surgeon for every 400,000 people. In India, there may be only one or two specialists for the entire country. Hence, far more training and capacity-building are needed.
Equally important is the recognition of breast reconstruction by insurance providers as a medical necessity rather than a cosmetic procedure. The development of one-stop centres offering diagnosis, surgery, reconstruction, and rehabilitation will further help make comprehensive care accessible and affordable.
A large study in India showed that women across ages, regions, and economic backgrounds strongly desire the option to restore their breasts after mastectomy. This preference is universal, yet their needs often remain unspoken or unheard. It is time to acknowledge these voices and ensure that women are not simply surviving cancer, but are enabled to return to their lives without the burden of a permanent physical reminder.
Offering breast reconstruction as a standard part of cancer care is not a luxury. It is a commitment to dignity, confidence, and complete rehabilitation. Every woman deserves the chance to move forward without deformity, and it is our responsibility as a healthcare system to make that possible.