Post-mastectomy breast reconstruction in sub-Saharan Africa: a scoping review of availability, uptake, techniques, outcomes, and barrier

Post-mastectomy breast reconstruction in sub-Saharan Africa: a scoping review of availability, uptake, techniques, outcomes, and barriers Breast cancer is the most commonly diagnosed cancer among women in sub-Saharan Africa (SSA), where survival is markedly lower than in high-income countries and most women undergo mastectomy rather than breast-conserving surgery. Mastectomy without reconstruction carries a documented quality-of-life and body-image cost, and fear of mastectomy is itself a recognised contributor to delayed presentation. Post-mastectomy breast reconstruction may improve quality of life and the acceptability of oncological surgery, yet its availability, uptake, techniques, outcomes, and the barriers to its provision across SSA remain poorly characterised. Existing African syntheses have addressed breast cancer surgery broadly and oncoplastic breast-conserving surgery specifically, but none has mapped post-mastectomy whole-breast reconstruction (implant-based or autologous flap, immediate or delayed) as a distinct field of practice in the region. The purpose of this scoping review is to systematically map the existing evidence on post-mastectomy breast reconstruction for women with breast cancer in SSA, in order to describe what is known, identify the techniques and settings reported, and locate the gaps that should guide future research and service planning. The review is conducted and reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR) and the methodological frameworks of Arksey and O'Malley, as refined by Levac and colleagues and operationalised by the Joanna Briggs Institute. Six databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL and African Journals Online) are searched alongside grey literature and reference-list screening, with sources screened in Rayyan and charted across five domains: availability and provision; uptake and techniques; patient perspectives and acceptability; oncological, aesthetic and quality-of-life outcomes; and barriers and facilitators. The expected outcome is a comprehensive evidence map demonstrating that post-mastectomy breast reconstruction in SSA is a sparse, geographically concentrated and largely unmapped field, in which reconstruction is most often characterised as scarce, centralised and unaffordable rather than as a procedure whose outcomes are reported. We anticipate that the evidence will cluster in the availability and patient-perspective domains, with near-absent technique-level and outcome-level data, and that the review will define an explicit research and service agenda, including the need for registries, prospective outcome studies and resource-stratified service planning, to support equitable, patient-centred breast cancer care in the region.