Colleen E. Witty

PURPOSE: The incidence of breast cancer is rising in Nigeria, with the majority of women presenting at advanced stages. Although mastectomy is the primary surgical treatment, many women fear mastectomy, leading to delayed presentation. Increasing awareness of and access to breast reconstruction after mastectomy is important to mitigate patient fear and encourage earlier presentation. An understanding of institutional and surgical workforce barriers is needed, yet has not been comprehensively studied nationwide. This study assessed barriers to breast reconstruction from the perspective of surgeons practicing in Nigeria. METHODS: In April 2024, a questionnaire was distributed to breast, general, and plastic surgeons across all six geopolitical zones in Nigeria via an online messaging platform. Demographics, practice patterns, and perceived barriers to breast reconstruction were collected. Plastic surgeons were further asked about microsurgical experience, training, and equipment. Descriptive statistical analysis was performed using R. RESULTS: Of the 440 invited, 66 (15.0%) surgeons completed the survey. Respondents were predominantly male (81.8%), consultants or fellows (72.7%), and practicing in public teaching hospitals (83.3%). The majority of general and breast surgeons reported performing fewer than five mastectomies per month, while most plastic surgeons had limited or no reconstruction caseloads. Late stage of patient presentation (84%) and poor referral pathways (75%) were the most frequently cited barriers. Additional clinical and institutional constraints were limited access to radiation therapy (62%), inadequate funding (58%), and perceived insufficient technical skill in reconstructive surgery (44%). High interest (90%) in microsurgical training was reported, although equipment access was inconsistent. CONCLUSION: Findings highlight the need for strengthened referral systems, improved surgical collaboration, and institutional support for training and infrastructure to expand access to breast reconstruction in Nigeria.