Breast Reconstruction in Oncology and Cosmetic Surgery: A Comparative Sociological Analysis

cinzia Headshot_CanvasBreast Cancer Consortium heartily congratulates BCC partner Cinzia Greco on the successful completion and formal defense of her dissertation research at the École des hautes études en sciences sociales (EHESS) and CERMES3 laboratory. Her comparative research in France and Italy explores how patients and doctors view and manage post-mastectomy breast reconstruction versus cosmetic breast surgery.

Overview of the Research

About 30 percent of women diagnosed with breast cancer in the French and Italian health care systems undergo mastectomy, which may be followed by reconstructive surgery. The latter, however, shares several features with aesthetic (cosmetic) breast surgery as well: many surgeons perform both kinds of operations, often using the same surgical techniques, and present them as a way to help women’s bodies adapt to typical canons of beauty.

  • What place does post-mastectomy reconstruction have in the therapeutic trajectories of breast cancer patients?
  • What are the difficulties met by women undergoing reconstruction? And what do women expect when undergoing the operation?
  • What about those who decide to live in an asymmetric body or without breasts?

This research examines these questions using a double comparative approach. First, reconstructive surgery is compared with aesthetic surgery. Second, it draws upon fieldwork conducted in France and Italy, including participant observation and 119 interviews with patients and medical professionals.

Outline of Chapters

Introduction and overview of the project.

Chapter 2 introduces readers to the contexts of the French and Italian health care systems, and the locations of the research.

Chapter 3 explores how conservative surgery and mastectomy differentiate the experience of the disease.

Chapter 4 considers the role of the different surgical techniques.

Chapters 5 and 6 examine the similarities between reconstructive surgery and aesthetic surgery. Part of the medical establishment tries to strengthen the links between the two types of surgeries to legitimize their work in both domains, but patients’ views are shaped by a different set of needs. For patients, the main aim is to have a body in which they can feel comfortable and that can help them to live a life that is as close as possible to their pre-diagnosis one. They are aware that this can be achieved even with an aesthetically imperfect surgical result.

Chapter 7 investigates the economic issues linked to breast reconstruction. In France, for example, many women are denied state-covered reconstruction surgery even though they are, in principle, entitled to it. Yet a scandal in 2010 surrounding adulterated breast implants (manufactured by Poly Implant Prothèse, or PIP) demonstrates how profit motives too often come before women’s health.

Chapter 8 focuses on women who did not undergo breast reconstruction and live instead with an asymmetric body. Their experiences highlight how the concept of reconstruction goes beyond surgical practices alone to include one’s acceptance of a different body as well as a different life, one that is modified by the experience of illness.

Key words: Breast cancer, reconstructive surgery, cosmetic surgery, body modifications, agency, domination, assemblage, health systems, gender, France, Italy

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