Cancer is an abnormal replication of cells in human body and is named based on the part of the body where the cell replication or growth is taking place. Abnormal growth of cells in the breast is termed breast cancer.¹ Breast cancer has been identified as the most common malignant disorder affecting women and the second leading cause of death among them after heart disease.² Developed countries have a higher incidence of breast cancer,³ while developing countries are experiencing an increase in the incidence with poor treatment outcomes because of late presentation and diagnosis.³ As early as 2008, the global estimate of breast cancer was as high as 1.38 million persons yearly⁴ with the number escalating in developing countries.^5,6,7 By the year 2020, breast cancer cases world-wide hit an alarming number of 2.26 million.⁸ While breast cancer exists around the globe, developed countries have a higher incidence rate and the incidence rate also varies by ethnicity and race.⁹

Breast cancer cases were historically low in Nigeria but are now increasing and has been identified as the major cause of death resulting from cancer.⁸ Breast cancer is currently attributed to 23% of all cancer cases and approximately 18% of deaths in the country.⁸

The incidence of breast cancer is increasing in the developing world because of increased life expectancy, increased urbanisation, and adoption of western lifestyles. Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries where breast cancer is often diagnosed in very late stages. In Nigerian women, breast cancer tends to be diagnosed at an advanced stage and the chances of survival are low.^10,11 Women in the country are also more frequently diagnosed with triple-negative breast cancer than women of European ancestry,¹² with cases occurring at a much younger age.¹³ As a result of the late presentation of the disease, the only options available are expensive treatments, which may be unaffordable for the average Nigerian woman. Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control.⁸

Jetha et al. found that majority of women diagnosed with breast cancer typically need some form of surgical intervention alongside additional treatment modalities such as radiation therapy, chemotherapy, and hormone therapy.¹⁴ Mastectomy is a common treatment modality for breast cancer in Nigeria. In certain cases, a mastectomy is performed to help prevent breast cancer in women who have a high risk of it. This includes women with hereditary genes commonly linked to breast cancer, such as the BRCA1, BRCA2 or PALB2 gene.

The alteration in breast appearance following mastectomy can significantly impact women’s self-image, causing a diminished sense of femininity and heightened feelings of anxiety and depression. These emotional effects are profound enough to deter women from frequenting public spaces.¹⁵

There is a possibility that they might find out that getting a breast reconstruction or external breast prosthesis (EBP) might be helpful to get through these struggles. Most women who underwent mastectomy select breast reconstruction and symmetrisation through surgery or by the use of EBP.¹⁵

External breast prosthesis is an artificial breast that is worn under clothing to imitate the shape of the breast. It can assist in both cosmetic restoration and weight balance for women who undergo mastectomy without reconstruction. Research conducted in developed nations indicates that EBP aids in alleviating stress and enhancing women’s self-esteem following mastectomy.¹⁶ However, the applicability of this phenomenon in developing countries such as Nigeria has yet to be investigated. The aim of this study is to evaluate the knowledge of post-mastectomy women regarding the use of EBP and its accessibility and affordability in the Southeast region of Nigeria.

This study uses a descriptive research design to assess the awareness, accessibility and affordability of the EBP by Nigerian women who had undergone mastectomy.

The participants were breast cancer survivors who had a mastectomy and who volunteered without any form of inducement, to participate in the study. The sampling technique was purposive and the study was conducted in three big cities in South Eastern Nigeria – Owerri, Enugu and Umuahia.

A total of 32 cancer survivors who had mastectomy were recruited for this study to assess the level of awareness of women who have undergone mastectomy regarding the use of the EBP and its availability and affordability in the Eastern region of Nigeria.

This study examined the knowledge of women who have had mastectomy on the usage of EBP, including their availability and cost in the Eastern region of Nigeria. The study included women in the age ranging from 20 to 70 years, with the age group of 41–50 years old accounting for the largest proportion of participants (37.5%). These women had their surgery within the past 6 months to 2 years.

A lack of information is one of the contributing factors affecting the use of EBP among these women, as the study revealed that many of the women who participated were unaware of the existence of this very important medical product, which according to Jetha, et al.,¹⁴ is important not only for cosmetic purposes but also for a balanced body posture, increased confidence, and improved socialisation.

Studies from different countries have also indicated that a significant barrier to the application of EBP is lack of information. Gallagher et al.¹⁷ discovered that a lack of knowledge of existence of EBP affected its use and thus deprived breast cancer survivors the joy they would have otherwise enjoyed knowing there is a solution to their body image distortion created by their mastectomy.

A study conducted by Qiu et al.¹⁸ similarly indicated a deficiency in information concerning the utilisation of EBP among Chinese patients, alongside a limited understanding among medical professionals regarding their usage.

The majority of the participants (85.7%) in the study did not know where or how to obtain EBP, and 4.8% said they could not afford EBP, highlighting a problem with accessibility and affordability. This study found that EBP is not widely available in Nigeria and that those who do use it import it, which further raises the cost. This is not unique to Nigeria and has been reported in previous studies from Ireland,^17,19,20 which revealed that the high cost of EBPs is a major challenge for women who use them. Likewise, in Canada, Fitch et al.²⁰ also reported that the cost and care of EBPs was the main concern of those women who were using them.

In high-income Western nations, following surgery, hospitals supply transitional breast prostheses to patients with breast cancer. A professional nurse counsels each patient individually regarding the best breast prosthesis based on their treatment plan and any underlying medical issues. This is performed to help women feel more confident and better about themselves, as well as to allow them to carry on with their regular daily activities. However, breast prosthesis is not covered by health insurance in poor nations such as China and Nigeria, and this puts financial strain on the patients.

From this study, we found out that most of the women who underwent mastectomy received psychological support before the procedure was performed. Mastectomy impacts not just a woman’s physical well-being but also her mental health, leading to a reluctance to engage socially. The assistance of healthcare professionals is crucial for patients’ families, especially when patients feel hesitant to openly seek information.

In terms of the information received before or after the mastectomy on the existence of the EBP, our result showed that majority of these breast cancer survivors, did not have any idea of its existence. Gallagher and colleagues¹⁸ discovered that insufficient knowledge about resulted in discontentment. Women may experience enhanced self-contentment and self-assurance through receiving sufficient guidance from their healthcare providers before and after the surgery. In addition, the dissemination of precise information by healthcare providers will help patients in comprehending the advantages of EBP. Findings also revealed that the few of these women who knew about the existence of these EBP, either didn’t know where to access it or either bought theirs abroad.

The study revealed that EBP is not easily accessible and available in Nigeria. Because of the lack of proper awareness of the existence of these EBP, most of the breast cancer treated patients were ignorant of its existence. Less than half of these patients who were aware of the existence of this device purchased theirs abroad because it is not available in the country. While patients that knew of its existence didn’t know where to purchase it from, proving further that it is not available, because if it is available, dealers will advertise them and people will get to know about them and their availability.

Healthcare organisations should create a platform to educate and create awareness of the existence and importance of these EBP for treated breast cancer patients. When these women are properly aware of the existence of these devices, it will make the demand of these devices higher in the market, thereby, making some organisations to look into manufacturing safe, durable and cosmetically pleasing EBP in Nigeria. The competition between these organisations will help to reduce prices of these devices, thereby making it affordable and accessible to these women.

Prosthetists and rehabilitation engineers should look at more cost effective methods and locally sourced materials to produce EBP locally, thereby making it affordable, available and accessible to breast cancer survivor in Nigeria.