Culture Impacts Sexual Well-Being in Autologous Breast Reconstruction: A Multi-Continental Examination

Abstract

Introduction: Sexual health concerns are prevalent in breast cancer patients, yet are difficult to address given the stigma, sensitivity, and cultural differences. This study aims to assess the impact of culture on Sexual Well-being after autologous breast reconstruction (ABR) by examining three different countries from different continents: South Korea for Asia, Netherlands for Europe, and United States of America (USA) for North America. Methods: Patients who underwent autologous (ABR) breast reconstruction between 2016 and 2022 and completed at least one BREAST-Q Sexual Well-being either preoperative and/or up to 2-year postoperative were included. Sexual Well-being was measured by BREAST-Q, a gold standard patient-reported outcome measure for breast cancer patients undergoing surgery. Results: A total of 1726 ABR patients were included, of which 173 were from Korea, 231 from Netherlands, and 1322 from USA. There were significant differences in BREAST-Q Sexual Well-being between the three countries at all timepoints (preoperative, 6-month, 1-year, and 2-year postoperative). In the linear regression model, relative to patients from USA, patients from Korea scored 13 points lower (beta = -13, 95% confidence interval [CI]: -17, -8.5, p < 0.001) while patients from the Netherlands scored 4.5 points higher (beta = 4.5, 95% CI: 1.7, 7.3, p = 0.002). Conclusion: In this multi-continental study, we found that Sexual Well-being among ABR patients significantly differs by culture. Additional insight and interventions into the lower Sexual Well-being among Asian patients at all timepoints and American patients postoperatively may be beneficial.