Breast reconstruction remains a controversial topic in the Middle East despite breast cancer being the most common cancer in women.1 Western Asia, which comprises the Arab world including the Middle East, had 55,914 new cases of breast cancer reported in 2018.1 Many of these patients will undergo surgical mastectomy and would be candidates for breast reconstruction.2 It is difficult to gauge the exact extent of reconstruction in the Middle East because of incomplete reporting of procedures. National cancer registries exist in the majority of the Middle Eastern countries; however, there are no national databases for surgical procedures. A study conducted on 91 breast cancer patients showed that only 16.5 percent of women underwent breast reconstruction after mastectomy in Jeddah, Saudi Arabia, between January and March of 2013.2 This is especially concerning, because Saudi Arabia has free health care, compared with neighboring countries. The low reconstruction rates can be attributed to a variety of factors, such as age; the availability of appropriate medical care; patient willingness to undergo further procedure; lack of surgical referrals; and cultural, educational, and religious backgrounds.2 The majority of women in the Middle East express a strong desire to restore breast aesthetics following mastectomy; however, they are ill-informed with regard to their options.3 Google Trends searches for the term “breast reconstruction” revealed few or no data for countries in the Middle Eastern countries, hinting at a lack of patient awareness. A significant cause is the scarcity of reconstructive referrals by general surgeons because of concerns about masking cancer recurrence despite no scientific basis.2,3 Furthermore, direct research output in the region is a mere 0.8 percent of the global research output in “breast cancer,” which is concerning because of the lack of up-to-date knowledge among physicians.4 Religious and cultural beliefs could be contributing factors to the low numbers of women opting for breast reconstruction within this region. Many of the Middle Eastern countries have Muslim majority populations, with the exception of Israel, a Jewish predominant state. In comparison to its neighboring countries, reconstruction rates in Israel were higher at 30 percent.5 Although Islam categorically supports breast reconstruction, there remains a discrepancy in interpretation combined with cultural influences. A study of 51 Saudi Arabian general surgeons demonstrated that only 88 percent believed that breast reconstruction complied with Sharia law.6 It is evident that further research is required to quantify the exact extent of breast reconstruction in the Middle East. However, it is apparent that this figure is low. Any solution will involve increased patient awareness and physician transparency; straightening out misconception will be essential. In addition, campaigns such as Breast Cancer Awareness Day, marathons for breast cancer, and extensive dialogue between patient and medical health care providers will be helpful in increasing patient education. Federal laws such as the Women’s Health and Cancer Rights Act in the United States could be helpful, and insurance policies should cover costs associated with breast reconstruction after mastectomy to further help patients. ACKNOWLEDGMENT This study was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. DISCLOSURE The authors declare that they do not have any conflicts of interest.