Dr. Salah al-Zaanin, a consultant laser and plastic surgeon, is preparing to conduct a breast reconstruction surgery in two weeks in his clinic in the Gaza Strip. The patient is a 37-year-old Palestinian woman who had a mastectomy due to cancer about four years ago.
Although breast cancer is the most common form of cancer among females in Palestine — accounting for 31.1% of the total number of cancer cases among women — breast reconstructive surgery is limited in a society where female patients undergo much suffering.
Testimonies provided to Al-Monitor show that women who have breast cancer and undergo a mastectomy may be abandoned by their husbands, get divorced or become a second wife.
Zaanin told Al-Monitor that in his private clinic in Gaza, he sometimes performs two cases of breast reconstructive surgery per month, while at other times four months may pass without any operation. He said that this is due to the financial crisis in the besieged enclave, although the cost of such a surgery in the Gaza Strip is very low compared to other countries and reaches a maximum of $3,000.
Zaanin also blamed the ignorance among a large number of affected women who are scared of undergoing surgery. Others who can afford the surgery are scared of talking about their experience because of social shame.
Zaanin said that all tools for breast augmentation and reconstruction surgery are available in Gaza, noting, “We have the experience and the capacity. The patient does not need to travel abroad to get the treatment. In case it is not available within certain specifications of silicon, we can get the right products within a week from the West Bank.”
In 2014, Ensaf Ismail was diagnosed with breast cancer at the age of 44. At that time, she did not think at all about the shape of her breast after the mastectomy. She only thought about her survival.
“In the beginning I was only concerned with getting rid of the cancerous mass in the breast, even if the price was a mastectomy. It was all to avoid a recurrence of the disease,” she told Al-Monitor.
After the difficult journey of treatment that she spent between Gaza and Jordan and the doctor's reassurance of recovery, Ismail began to think about breast reconstruction surgery.
Ismail visited specialized centers and institutions supporting cancer patients in the Gaza Strip to learn more about this surgery. There, she met many cancer survivors who have had various experiences; some women even refused mastectomy despite the threat to their lives.
Ismail, who is also going through a divorce from her husband since the start of her illness, said, “There are hundreds of women with breast cancer who have a severe phobia of losing their breasts in exchange for getting rid of cancer. Sometimes they refuse a mastectomy because they do not know about the plastic surgery [breast reconstruction] option or because of poverty. We have made a great effort to convince them of the need for treatment in the hope that they will later undergo plastic surgery.”
Ismail, a mother of two girls, explained that in 2020, the cancer spread to her other breast. “After this I was very tired of surgeries, examinations, chemotherapy and hormonal treatments. With the high cost of plastic surgery operations in Gaza, I no longer thought of anything but overcoming this disease," she said.
In 2018, Dr. Wael Weshah, consultant and general surgery specialist, succeeded with the help of his medical team in performing the first breast reconstruction operation in the Gaza Strip. This operation gave great hope for many breast cancer patients in Gaza.
Weshah told Al-Monitor that all types of plastic and breast reconstruction surgeries are available in Gaza, be it silicon restoration or restoration by muscle or fat implants.
However, Weshah said that despite the psychological and social importance of the reconstruction surgery, women often avoid undergoing the operation because of the economic situation in Gaza.
Weshah urged the concerned institutions to support plastic surgery for female cancer patients, especially young women who are often abandoned by their husbands.
The Aid and Hope Program, a nonprofit organization based in Gaza City, which provides psychological support for women diagnosed with breast cancer, manufactures artificial breasts and offers them free of charge to the patients.
The program’s founder, Iman Shanan, told Al-Monitor that a group of female cancer survivors manufacture these breasts to help others overcome what they have been through. According to her, many women feel ashamed during social events or when they go to the doctor. She added, “Breast compensation has helped women become more powerful and accepting.”
Shanan stressed that breast reconstruction is the dream of every woman who has suffered from breast cancer in Gaza. There are women who have been abandoned by their husbands, while other young unmarried women lost hope.
She noted, “Mastectomy for young women implies psychological and social suffering. Add to that chemotherapy, radiation and hormonal treatment. Then, the biggest problem becomes aesthetics that [many women] can’t afford to solve [through reconstruction surgery] because of poor medical and surgical capabilities, and sometimes poor economic status.”