Barriers to Accessing Post-Mastectomy Breast Reconstruction in Latin America and the Caribbean: A Scoping Systematic Review

Breast reconstruction is associated with improved quality of life after mastectomy; however, in Latin America and the Caribbean, access remains limited due to structural inequities, delays, and shortages of specialized personnel. To map and synthesize the evidence on access to post-mastectomy breast reconstruction in Latin America and the Caribbean, identifying barriers, facilitators, and research gaps. A scoping review was conducted. Searches were performed in PubMed, Scopus, Web of Science, SciELO, and LILACS for studies published between 2010 and 2025, with no language restrictions (English, Spanish, and Portuguese). Of 4212 records identified, 26 studies met the inclusion criteria. Most studies were observational, complemented by economic evaluations, qualitative studies, and administrative analyses. Evidence was concentrated in Brazil and Mexico, with smaller contributions from Peru, Colombia, Cuba, Chile, and Venezuela. Identified barriers included economic (lack of coverage, out-of-pocket costs), geographic (urban concentration, need for long-distance travel), health system-related (shortage of specialists, limited infrastructure and microvascular capacity), clinical/institutional (restricted training and technical complexity), and sociocultural (information gaps, stigma, cultural beliefs). Reconstruction was consistently associated with a higher quality of life (BREAST-Q, SF-36) and favorable cost-effectiveness in selected settings. Structural and equity barriers to breast reconstruction persist in Latin America and the Caribbean. Public health policies should explicitly include breast reconstruction, particularly immediate procedures in benefit packages; expand microvascular surgery capacity through hub-and-spoke models; strengthen specialist training; and implement patient navigation and standardized counseling to ensure timely, safe, and equitable access.