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Decision-Making about Postmastectomy Breast Reconstruction among Lesbian and Bisexual Women
Unformatted Document Text:  Introduction: Breast cancer patients face a cascade of treatment decisions. For mastectomy patients, this may include deciding about breast reconstruction. Despite the burgeoning literature on decision-making regarding breast reconstruction, few studies have examined the decision-making process among minorities, particularly sexual minorities. The near absence of sexual minority women from this research is striking, as studies suggest that lesbians may face increased for breast cancer (Denenberg, 1995). Current knowledge about factors influencing women’s use and satisfaction with reconstruction is based on hetero-normative conceptualizations of body image and sexuality; however, studies suggest differences in body image among lesbian and bisexual women as compared with heterosexuals (Morrison, Morrison, & Sager, 2004). Methods: Lesbian and bisexual women participating in internet or community-based support groups were invited to participate in an ongoing study of decision-making about breast-reconstruction among minority women. To date, thirteen in-depth interviews have been conducted with lesbian women (mean age = 44) both with (N = 11) and without (N = 2) reconstruction. All interviews were transcribed and analyzed using grounded theory methodology. Results: Emergent themes in this sample include (a) the role of cancer distress in women’s decision-making; (b) differing values between patients and plastic surgeons regarding physical appearance and functioning; (c) impact of cancer/mastectomy/reconstruction on romantic relationships; and (d) impact of dating/sexuality on decision-making. Although participants admired women who opted against reconstruction, those undergoing reconstruction felt having breasts was important to body image, sexuality, and “looking normal.” Participants rejected stereotypes that lesbians are less invested in breast reconstruction postmastectomy than heterosexual women. Participants stressed the value of a uniquely lesbian/bisexual support group in coping with breast cancer and its aftermath for both themselves and their partners. Conclusions: Our findings differ somewhat from a previous study (Boehmer, Line, & Freund, 2007), the only published research on this topic. Studies of quality-of-life among breast cancer patients must include lesbian and bisexual women. Qualitative methods promote understanding of patients’ experience, without imposing a priori assumptions, and are well-suited for studies of groups under-represented in psycho-oncology research. Healthcare professionals should avoid making assumptions about women’s healthcare needs based on sexual orientation, and should be aware of the unique support needs of sexual minority women who have survived breast cancer, and the support needs of their partners. References: Boehmer, U.,Linde, R., & Freund, K. (2007). Breast Reconstruction following Mastectomy for Breast Cancer: The Decisions of Sexual Minority Women. Plastic & Reconstructive Surgery, 119, 464-472.

Authors: Rubin, Lisa.
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Introduction: Breast cancer patients face a cascade of treatment decisions. For 
mastectomy patients, this may include deciding about breast reconstruction. Despite the 
burgeoning literature on decision-making regarding breast reconstruction, few studies 
have examined the decision-making process among minorities, particularly sexual 
minorities. The near absence of sexual minority women from this research is striking, as 
studies suggest that lesbians may face increased for breast cancer (Denenberg, 1995). 
Current knowledge about factors influencing women’s use and satisfaction with 
reconstruction is based on hetero-normative conceptualizations of body image and 
sexuality; however, studies suggest differences in body image among lesbian and 
bisexual women as compared with heterosexuals (Morrison, Morrison, & Sager, 2004). 
Methods: Lesbian and bisexual women participating in internet or community-based 
support groups were invited to participate in an ongoing study of decision-making about 
breast-reconstruction among minority women. To date, thirteen in-depth interviews have 
been conducted with lesbian women (mean age = 44) both with (= 11) and without (N 
= 2) reconstruction. All interviews were transcribed and analyzed using grounded theory 
methodology. Results: Emergent themes in this sample include (a) the role of cancer 
distress in women’s decision-making; (b) differing values between patients and plastic 
surgeons regarding physical appearance and functioning; (c) impact of 
cancer/mastectomy/reconstruction on romantic relationships; and (d) impact of 
dating/sexuality on decision-making. Although participants admired women who opted 
against reconstruction, those undergoing reconstruction felt having breasts was important 
to body image, sexuality, and “looking normal.” Participants rejected stereotypes that 
lesbians are less invested in breast reconstruction postmastectomy than heterosexual 
women. Participants stressed the value of a uniquely lesbian/bisexual support group in 
coping with breast cancer and its aftermath for both themselves and their partners. 
Conclusions: Our findings differ somewhat from a previous study (Boehmer, Line, & 
Freund, 2007), the only published research on this topic. Studies of quality-of-life among 
breast cancer patients must include lesbian and bisexual women. Qualitative methods 
promote understanding of patients’ experience, without imposing a priori assumptions, 
and are well-suited for studies of groups under-represented in psycho-oncology research. 
Healthcare professionals should avoid making assumptions about women’s healthcare 
needs based on sexual orientation, and should be aware of the unique support needs of 
sexual minority women who have survived breast cancer, and the support needs of their 
partners. 
References: 
Boehmer, U.,Linde, R., & Freund, K. (2007). Breast Reconstruction following 
Mastectomy for Breast Cancer: The Decisions of Sexual Minority Women. Plastic & 
Reconstructive Surgery, 119,
 464-472. 


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