Assessment of knowledge, awareness, perceptions, and attitudes toward breast reconstruction practice among medical students in Jordan: a cross-sectional study

Abstract

Background and purpose

Breast reconstruction (BR) following mastectomy is one component of comprehensive breast cancer care; however, its educational emphasis, accessibility, and cultural context vary across health systems, particularly in middle-income countries. Understanding how future physicians perceive BR within the local epidemiologic and health-system landscape is necessary to guide proportionate and culturally responsive medical education. This study assessed knowledge, awareness, perceptions, and attitudes toward BR among Jordanian medical students, with the aim of identifying educational gaps and barriers to practice.

Methods

A national cross-sectional study was conducted among clinical-year medical students (years 4–6) from six Jordanian universities using a validated, self-administered questionnaire. A validated, self-administered questionnaire was distributed electronically via institutional mailing lists and verified student communication platforms. The survey was developed following expert review and piloting for clarity and cultural appropriateness. Data were analyzed descriptively to evaluate students’ educational exposure, knowledge, confidence, and perceptions regarding BR.

Results

Of 391 respondents, 69.6% were female and all universities were represented. While 79% reported prior teaching on breast cancer, only 21% attended lectures specifically on BR, and 20.2% observed a procedure. Most rated their knowledge as basic (58.8%), with only 1.3% reporting advanced knowledge. Confidence in counseling patients was limited, with 7.2% feeling very confident. Awareness of key aspects varied: 42.2% recognized both immediate and delayed reconstruction, 55% knew both implant and autologous options, and 57.3% were unsure about insurance coverage. Reported barriers included financial cost (85.2%), lack of awareness (68.3%), and cultural or religious sensitivity (> 60%). Despite this, 88.7% agreed BR improves quality of life, and 75.7% supported greater curricular emphasis, with 68.3% seeking additional training.

Conclusion

Jordanian medical students demonstrate supportive attitudes toward BR but significant educational and systemic gaps remain. Strengthening BR education and addressing cultural and financial barriers are essential to empower future physicians in promoting patient-centered cancer care.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09290-9.

Introduction

Breast cancer is the most frequently diagnosed cancer among women worldwide, accounting for approximately 2.3 million new cases in 2020 and representing 11.7% of all cancer diagnoses globally [1]. In Jordan, breast cancer is the most common malignancy among women, accounting for approximately 39–40% of all female cancer cases according to the Jordan Cancer Registry [2]. The median age at diagnosis is relatively young, around 50–52 years, which is nearly a decade earlier than that reported in many Western populations [3, 4]. Despite national screening initiatives, a considerable proportion of patients continue to present with locally advanced disease (approximately 40–50%), and variations in stage at diagnosis and survivorship outcomes persist [5, 6]. Within this context, breast reconstruction represents one component of comprehensive cancer care whose relevance depends on patient preference, clinical factors, and health-system capacity.

Advances in early detection and treatment have significantly improved survival rates, shifting the focus from merely extending life to optimizing quality of life and psychosocial well-being [7]. One important aspect of survivorship care is breast reconstruction (BR) following mastectomy, which may contribute to psychosocial recovery and quality of life for selected patients, depending on individual preference, oncologic context, and resource availability [8–10].

Breast reconstruction can be performed using various techniques, including implant-based methods and autologous tissue reconstruction, and may be offered either immediately at the time of mastectomy or in a delayed fashion [11]. The decision to undergo BR is multifactorial, influenced by clinical factors (such as cancer stage and comorbidities), patient preference, surgeon expertise, financial considerations, and cultural or religious beliefs [9, 12]. Despite the proven benefits, utilization of BR varies widely across countries and within populations, particularly in low- and middle-income countries (LMICs), where barriers such as limited resources, lack of awareness, insufficient surgical expertise, and sociocultural stigma remain significant [13–15].

In the Middle East, sociocultural values, family structures, and personal faith traditions may shape how patients interpret illness, body image, and surgical decision-making. These influences are complex and should not be interpreted solely as barriers but as part of broader health-behavior frameworks [16–18]. Studies have suggested that conservative views about body image, societal perceptions, and modesty can affect willingness to consider BR [19]. Additionally, public and professional awareness about reconstructive options remains limited in many Arab countries [20, 21]. Jordan, a middle-income country in the Eastern Mediterranean region, has a relatively high breast cancer burden, with breast cancer being the most common malignancy among Jordanian women [4]. While BR services are available in select tertiary hospitals, accessibility and uptake remain suboptimal, partly due to insufficient patient counseling and gaps in healthcare professionals’ knowledge [22, 23].

Medical students, as future healthcare providers, play a critical role in patient education and advocacy for reconstructive options. Their knowledge, awareness, and perceptions can influence the quality of preoperative counseling and postoperative support that breast cancer patients receive [24]. However, research evaluating medical students’ understanding of BR in Jordan is scarce, and little is known about the influence of sociocultural factors on their attitudes toward this practice. Addressing this knowledge gap is essential for guiding curriculum development and promoting patient-centered cancer care.

Therefore, this study aims to assess the knowledge, awareness, perceptions, and attitudes of medical students in Jordan toward breast reconstruction following mastectomy, and to identify potential educational gaps and barriers to practice. Findings from this study will provide insights that could inform targeted educational interventions and public awareness campaigns, ultimately improving access to and acceptance of reconstructive options for breast cancer patients in Jordan.

Methods

Study design and setting

This study was designed as a cross-sectional, questionnaire-based survey conducted among medical students enrolled at accredited medical schools in Jordan. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies [25]. Data collection was carried out between May/2025 and Jul/2025, online via a secure Google Forms link distribution.

Study population

The study targeted medical students enrolled in Jordanian medical schools during the time of data collection. Since breast reconstruction (BR) is primarily encountered in surgical, oncological, and clinical practice settings, the focus was placed on students in the clinical phase of their education, where exposure to patient care and relevant curricula is expected to be more substantial. This focus was intended to ensure that participants had at least potential exposure to surgical and oncologic concepts relevant to breast reconstruction.

Medical education in Jordan follows a six-year undergraduate-entry model, with clinical exposure primarily occurring during the final three years (years 4–6).

Inclusion criteria

Medical students in their clinical years (4th, 5th, and 6th year) enrolled in Jordanian medical schools, and willingness to voluntarily participate in the study, as indicated by providing informed consent prior to completing the questionnaire.

Exclusion criteria

Medical graduates, interns, and healthcare professionals who had already completed their medical degree were excluded to ensure that the study population reflected only current medical students. Additionally, incomplete submissions, duplicate responses, and those flagged as inconsistent (based on timestamp, IP address, and response pattern analysis) were excluded from the final dataset to maintain data integrity and reliability.

Sampling strategy

A stratified convenience sampling approach was used to ensure representation from multiple universities and academic years. Medical schools in Jordan were categorized into two strata based on location (northern, central, and southern regions) and university type (public or private). Efforts were made to include students from each clinical (years 4–6) levels.

Sample size calculation

Sample size was calculated using Cochran’s formula for cross-sectional studies:

where:

Z = 1.96 for a 95% confidence level.

p = assumed proportion of adequate knowledge on breast reconstruction = 0.5 (maximum variability, conservative estimate).

e = margin of error = 0.05.

This yielded a minimum required sample size of 384 participants. To account for potential non-response or incomplete questionnaires, the target was increased by 10%, resulting in a final target of approximately 422 participants.

The total number of eligible medical students across all Jordanian universities during the study period could not be precisely determined due to variability in publicly available enrollment data; therefore, a response rate could not be calculated. However, a total of 422 questionnaires were distributed, of which 391 complete responses were received and included in the final analysis.

Data collection tool

A self-administered structured questionnaire was developed based on a review of existing literature assessing knowledge, awareness, and attitudes toward breast reconstruction in healthcare settings [20, 21, 26, 27] and expert input from surgical oncologists, plastic surgeons, and medical education specialists in Jordan. The final questionnaire consisted of five main sections covering: (1) demographics and prior exposure to breast reconstruction; (2) knowledge of reconstruction types, timing, and complications; (3) awareness and information sources; (4) perceptions and attitudes using Likert-scale items; and (5) perceived barriers and recommendations.

Pilot testing and validation

The questionnaire was piloted on 10 medical students (excluded from the final analysis) to ensure clarity, relevance, and face validity. Feedback was used to refine wording, question order, and response options. Content Validity was assessed by a panel of three breast surgery experts and two medical education specialists. Reliability Testing was conducted on the pilot responses, internal consistency for Likert-scale items was assessed using Cronbach’s alpha (α ≥ 0.70 considered acceptable). Test–retest reliability was checked in a subset of 10 students over a 2-week interval using the intraclass correlation coefficient (ICC).

Data collection procedure

The Google Forms link was preceded by an electronic consent statement explaining the study purpose, voluntary nature of participation, anonymity, and estimated completion time (6–8 min). Participants had to check “I agree” to proceed. To avoid duplicate online responses, the Google Form was configured to allow only one response per Google account and timestamps were reviewed for anomalies.

The questionnaire link was administered electronically via institutional mailing lists and student communication platforms. The survey was conducted in English, consistent with the language of medical instruction in Jordan.

Data management and statistical analysis

Online responses were exported directly from Google Forms into Microsoft. Statistical analyses were performed using Jamovi software (Version 2.6.26). Descriptive statistics were used to summarize the data: categorical variables were reported as frequencies and percentages, while continuous variables were expressed as means with standard deviations (SD) or medians with interquartile ranges (IQR), as appropriate.

Result

Demographics

A total of 391 medical students participated, with a mean age of 22.5 ± 1.7 years (range: 21–26). Most were female (69.6%, n = 272), while males comprised 30.4% (n = 119). Students were recruited from six Jordanian universities, mainly Al-Balqa Applied University (37.6%), followed by the University of Jordan (17.1%), Yarmouk University (16.9%), Jordan University of Science and Technology (16.4%), Hashemite University (6.6%), and Mutah University (5.4%). Regarding academic year, 32.2% were in the 4th, 37.9% in the 5th, and 29.9% in the 6th year of study. (Table 1).

Table 1.

Demographic characteristics of clinical-year medical students (N = 391)

	Overall (N = 391)
Age
Mean (SD)	22.5 (1.7)
Range	21.0—26.0
Gender
Female	272 (69.6%)
Male	119 (30.4%)
University
BAU	147 (37.6%)
HU	26 (6.6%)
JUST	64 (16.4%)
MU	21 (5.4%)
UJ	67 (17.1%)
YU	66 (16.9%)
Year of study:
4th	126 (32.2%)
5th	148 (37.9%)
6th	117 (29.9%)

Abbreviations: BAU Beirut Arab University, HU Hashemite University, JUST Jordan University of Science and Technology, MU Mutah University, UJ University of Jordan, YU Yarmouk University, SD Standard Deviation

Breast cancer and reconstruction education and exposure

Among the 391 surveyed medical students, 79.0% (n = 309) had received formal teaching on breast cancer or breast reconstruction, while 21.0% (n = 82) had not. Clinical exposure was reported by 47.8% (n = 187), whereas 52.2% (n = 204) had not encountered related patients. Only 21.0% (n = 82) attended lectures or workshops specifically on breast reconstruction, and 20.2% (n = 79) had observed a reconstruction procedure during clinical rotations, compared with 79.8% (n = 312) who had not. (Table 2).

Table 2.

Educational exposure to breast cancer and breast reconstruction among clinical-year medical students (N = 391)

	Overall (N = 391)
Have you received any formal teaching about breast cancer or reconstruction in your curriculum?
No	82 (21.0%)
Yes	309 (79.0%)
Have you encountered patients who underwent mastectomy or breast reconstruction
No	204 (52.2%)
Yes	187 (47.8%)
Have you attended any lectures or workshops specifically about breast reconstruction
No	309 (79.0%)
Yes	82 (21.0%)
Have you seen a breast reconstruction procedure during your clinical rotations
No	312 (79.8%)
Yes	79 (20.2%)

Knowledge and perceptions of breast reconstruction

Most students rated their knowledge of breast reconstruction as basic (58.8%), with fewer reporting moderate (22.3%) or no knowledge (17.6%), and only 1.3% describing it as advanced. While 77.0% correctly defined breast reconstruction as a post-mastectomy reconstructive surgery, 12.8% considered it cosmetic, and 10.2% were unsure. Regarding timing, 42.2% recognized it can be immediate or delayed, while others believed it was limited to post-treatment (25.8%), immediate only (7.4%), or were uncertain (24.6%). For techniques, 55.0% knew both implants and autologous tissue are used, whereas 24.6% did not know, 12.5% selected tissue only, and 7.9% implants only. Most (68.3%) understood eligibility depends on health and oncologic status, though some thought it applied to all patients (8.7%), only younger patients (4.6%), or were unsure (18.4%). On insurance coverage, 57.3% were uncertain, 33.2% believed it is not covered, and 9.5% thought it is. (Table 3).

Table 3.

Knowledge and awareness of breast reconstruction among clinical-year medical students (N = 391)

	Overall (N = 391)
How would you rate your prior Know ledge of breast reconstruction
Advanced	5 (1.3%)
Basic	230 (58.8%)
Moderate	87 (22.3%)
None	69 (17.6%)
Breast reconstruction is
A Cosmetic procedure	50 (12.8%)
A reconstructive surgical post-mastectomy	301 (77.0%)
Not sure	40 (10.2%)
When can breast reconstruction be offered
Both	165 (42.2%)
Delayed (after treatment)	101 (25.8%)
Immediately post-mastectomy	29 (7.4%)
Not sure	96 (24.6%)
Which techniques are used for breast reconstruction
Autologous tissue (flaps)	49 (12.5%)
Both	215 (55.0%)
Don't know	96 (24.6%)
Implants	31 (7.9%)
Who is a suitable candidate for breast reconstruction
All patients	34 (8.7%)
Depends on health/oncologic status	267 (68.3%)
Not sure	72 (18.4%)
Only younger patients	18 (4.6%)
Is breast reconstruction covered by Jordanian public health insurance
No	130 (33.2%)
Not sure	224 (57.3%)
Yes	37 (9.5%)

Confidence and educational needs related to breast reconstruction

Most students reported limited confidence in explaining breast reconstruction options, with 32.0% neutral, 29.7% not confident, and 11.5% not at all confident. Only 19.7% felt somewhat confident, and 7.2% very confident. Reflecting this, 68.3% expressed a clear need for more education, 23.5% answered “maybe,” and 8.2% said “no.” Furthermore, 75.7% agreed that breast reconstruction should be emphasized more in the medical curriculum, compared with 15.6% who were unsure and 8.7% who disagreed. (Table 4).

Table 4.

Confidence and educational needs regarding breast reconstruction among clinical-year medical students (N = 391)

	Overall (N = 391)
How confident are you in your ability to explain reconstruction options to a patient
Neutral	125 (32.0%)
Not at all confident	45 (11.5%)
Not confident	116 (29.7%)
Somewhat confident	77 (19.7%)
Very confident	28 (7.2%)
Would you like more education/training about breast reconstruction
Maybe	92 (23.5%)
No	32 (8.2%)
Yes	267 (68.3%)
Do you think breast reconstruction should be emphasized more in the medical curriculum
No	34 (8.7%)
Not sure	61 (15.6%)
Yes	296 (75.7%)

Awareness of potential complications of breast reconstruction

Most students reported awareness of common complications, with infection (72.4%), implant rupture (66.5%), flap necrosis (64.2%), and hematoma (56.8%) being the most frequently identified. However, 14.6% reported not knowing any potential complications, highlighting a gap that underscores the need for further educational emphasis. (Fig. 1).

Fig. 1.

Frequency of Potential Complications Identified by Clinical-Year Medical Students After Breast Reconstruction

Factors influencing the choice of reconstruction method

Students most frequently identified patient preference (73.7%) and medical condition (69.1%) as key determinants of reconstruction method, underscoring the roles of shared decision-making and clinical eligibility. Financial situation (60.9%) and surgeon expertise (58.1%) were also widely recognized as influential. However, 12.3% were unsure about these factors, reflecting a need for more focused education on decision-making in breast reconstruction. (Fig. 2).

Fig. 2.

Factors that influence the choice of breast reconstruction Identified by Clinical-Year Medical Students

Perceptions of services, insurance, and barriers to access

Only 20.2% of students believed breast reconstruction services in Jordan are sufficient, while 38.1% viewed them as insufficient and 41.7% were unsure. Awareness of insurance coverage was also limited: 9.5% thought public health insurance covers reconstruction, 33.3% believed it does not, and 57.3% were uncertain. Regarding barriers, financial cost was the most frequently cited (85.2%), followed by lack of awareness (68.3%), fear of complications (55.8%), religious or cultural beliefs (55.0%), limited access to trained surgeons (49.4%), and lack of family support (48.1%). A small minority (2.6%) mentioned other factors. (Table 5).

Table 5.

Perceptions and barriers to breast reconstruction services

	Count	%
Do you believe there are sufficient services for breast reconstruction in Jordan
No	149	38.11%
Not sure	163	41.69%
Yes	79	20.20%
Is breast reconstruction covered by Jordanian public health insurance
No	130	33.25%
Not sure	224	57.29%
Yes	37	9.46%
the main barriers preventing patients from accessing breast reconstruction in Jordan
Financial cost	333	85.17%
Lack of awareness	267	68.29%
Limited access to trained surgeons	193	49.36%
Religious/cultural beliefs	215	54.99%
Fear of complications	218	55.75%
Lack of family support	188	48.08%
Other	10	2.56%

Perceptions of media and public campaigns

Nearly half of the students (46.0%) agreed that media and public campaigns help raise awareness about breast reconstruction, while 25.3% were neutral and 28.6% disagreed. These findings may suggest that although many students acknowledge the potential of media outreach, there is considerable skepticism and uncertainty about the effectiveness of current efforts, underscoring the need for more targeted and culturally sensitive public education initiatives in Jordan. (Fig. 3).

Fig. 3.

Perceptions of Media and Public Campaigns in Promoting Breast Reconstruction Awareness

Attitudes toward breast reconstruction

Most students expressed positive attitudes toward breast reconstruction, with 88.7% agreeing it improves quality of life and self-esteem, while only 0.6% disagreed and 10.7% were neutral. Similarly, 86.7% supported that every woman should be informed about reconstruction options post-mastectomy, with just 1.3% disagreeing and 12.0% neutral. However, views were more divided on integrating reconstruction into the oncologic treatment plan: 50.4% agreed, 26.6% were neutral, and 23.0% disagreed. Overall, students strongly endorsed patient education and acknowledged the psychosocial benefits of reconstruction, though uncertainty remained regarding its formal integration into cancer care pathways. (Table 6).

Table 6.

Attitudes toward breast reconstruction after mastectomy among clinical-year medical students

	Overall (N = 391)
Breast reconstruction improves quality of life and self-esteem post-mastectomy
Agree	178 (45.5%)
Disagree	1 (0.3%)
Neutral	42 (10.7%)
Strongly Agree	169 (43.2%)
Strongly Disagree	1 (0.3%)
Every woman should be informed about reconstruction options after mastectomy
Agree	136 (34.8%)
Disagree	3 (0.8%)
Neutral	47 (12.0%)
Strongly Disaree	2 (0.5%)
Strongly agree	203 (51.9%)
Breast reconstruction should be integrated in to the oncologic treatment plan
Agree	148 (37.9%)
Disagree	25 (6.4%)
Neutral	104 (26.6%)
Strongly Agree	49 (12.5%)
Strongly Disagree	65 (16.6%)

Cultural and religious influences on breast reconstruction

Students perceived cultural and religious factors as influential in patients’ decisions regarding breast reconstruction in Jordan. Most agreed that cultural norms affect decisions (63.2% agreeing/strongly agreeing), with 28.6% neutral and 8.2% disagreeing. Similarly, 59.1% viewed discussions about reconstruction as culturally sensitive, while 27.1% were neutral and 13.9% disagreed. Regarding stigma, 51.2% agreed it affects willingness to undergo reconstruction, 28.4% were neutral, and 20.5% disagreed. Opinions on religious influences were more mixed: 33.3% agreed that perceived religious beliefs may discourage reconstruction, 28.9% disagreed, and 37.9% were neutral, highlighting variability and uncertainty in perceived religious impact. (Table 7).

Table 7.

Perceived cultural and religious barriers to breast reconstruction among clinical-year medical students

	Overall (N = 391)
I believe cultural views in Jordan influence patients' decisions about breast reconstruction
Agree	160 (40.9%)
Disagree	28 (7.2%)
Neutral	112 (28.6%)
Strongly Agree	87 (22.3%)
Strongly Disagree	4 (1.0%)
Discussing breast reconstruction is sensitive in our cultural and religious context
Agree	159 (40.7%)
Disagree	53 (13.6%)
Neutral	106 (27.1%)
Strongly Agree	72 (18.4%)
Strongly Disagree	1 (0.3%)
Cultural stigma affects patients' willingness to undergo breast reconstruction
Agree	152 (38.9%)
Disagree	59 (15.1%)
Neutral	111 (28.4%)
Strongly agree	48 (12.3%)
Strongly disagree	21 (5.4%)
Religious beliefs discourage patients from seeking breast reconstruction
Agree	98 (25.1%)
Disagree	69 (17.6%)
Neutral	148 (37.9%)
Strongly agree	32 (8.2%)
Strongly disagree	44 (11.3%)

Discussion

Jordanian medical students showed limited knowledge and clinical exposure to breast reconstruction after mastectomy, with many reporting only basic understanding of techniques, timing, and complications. System-level barriers—including financial costs, lack of awareness, cultural and religious factors, and limited access to trained surgeons—were widely recognized. Confidence in counseling patients was low, yet students expressed strong interest in additional education and curriculum integration. Attitudes were generally positive regarding the psychosocial benefits of reconstruction and informing patients, though views were mixed on integrating it into oncologic treatment. These findings should be interpreted within the broader context of healthcare system capacity in Jordan, where competing priorities in cancer care may limit emphasis on reconstructive services. These findings highlight potential educational gaps, underscoring the need for enhanced, context-specific training in breast reconstruction.

This study provides an initial description of how medical students in Jordan understand breast reconstruction within their current educational exposure and clinical environment. Rather than indicating a uniform deficit, the findings reflect the way specialized reconstructive topics are encountered in a resource-conscious medical system. This aligns with reports from other Middle Eastern countries such as Saudi Arabia and, where medical students and junior physicians also exhibited low familiarity with reconstructive options following mastectomy [20, 28]. By contrast, studies from Western countries, particularly the United States and Europe, report higher levels of awareness, likely due to the inclusion of reconstructive concepts in medical curricula and greater clinical exposure during surgical rotations [29]. This discrepancy may also reflect differences in resource allocation and prioritization of reconstructive services, where high-income healthcare systems are more likely to integrate reconstruction as a standard component of oncologic pathways. These international comparisons underscore the gap in undergraduate medical education in Jordan and the wider region regarding BR.

However, in a large UK-based study involving 2,513 medical students, breast reconstruction was the most accurately recognized plastic surgery procedure (91.8%). Nonetheless, the same study found that 56.3% of students had no formal plastic surgery education, and only 6.2% had clinical exposure, suggesting that recognition alone does not equate to competence or confidence [30].This aligns closely with our findings, in which fewer than one in five Jordanian students had attended a BR-related workshop or observed a procedure, and only 7.2% felt very confident discussing it with patients. This may suggest that beyond curriculum presence, structured clinical exposure and workforce availability play a critical role in translating knowledge into confidence.

This educational gap may be especially problematic given that patient engagement with BR remains suboptimal across multiple regions. A study conducted in Saudi Arabia found that only 16.5% of women underwent BR following mastectomy. Key barriers included lack of adequate information (63%), fear of complications (68%), and concern that reconstruction might interfere with detecting cancer recurrence (54%) [31]. These data emphasize the essential role of physician communication and underscore the importance of training medical students to address patient concerns confidently and accurately. In settings such as Jordan, where consultation time and specialist availability may be limited, inadequately trained physicians may further exacerbate disparities in patient access to reconstruction.

Beyond educational exposure, cultural and religious norms in Jordan appear to significantly shape students’ attitudes toward BR. However, these influences should be interpreted cautiously, as religiosity was not directly measured and likely reflects students’ perceptions of sociocultural norms rather than defined theological positions. The variability and neutrality observed in responses may suggest uncertainty rather than clear religious opposition. Thus, framing religion solely as a barrier may be reductive. Instead, cultural and faith-based frameworks may also support coping, shared decision-making, and illness meaning-making. Factors such as modesty, family involvement, and preferences for gender-concordant care may play a more significant role than doctrinal restrictions. [32]

In this context, misconceptions—such as viewing BR as purely cosmetic—remain prevalent among students and may contribute to underutilization [18, 33, 34]. Addressing these gaps through culturally sensitive medical education and improved communication strategies is essential to position BR as an integral component of comprehensive cancer care.

Findings suggest an opportunity to introduce proportionate exposure to reconstructive principles within oncology and surgery rotations, aligned with national workforce capacity and patient demand. At present, exposure to reconstructive options is limited and often confined to postgraduate surgical training [21]. International experience shows that even brief educational interventions, such as lectures or case-based discussions, can significantly improve student understanding and positive attitudes toward BR [35–37]. A recent Jordanian study demonstrated that medical students who underwent a plastic surgery rotation had higher knowledge scores, were more confident in procedure allocation, and relied more on direct clinical exposure rather than media for their understanding of surgical procedures compared to students without such exposure [38]. This highlight that introducing multidisciplinary teaching sessions, involving both breast and plastic surgeons, could ensure that medical students view BR as part of comprehensive oncologic care. Such integration reflects the need to align undergraduate education with existing surgical-oncology infrastructure, where coordination between specialties remains essential but may not be uniformly implemented across institutions. Furthermore, simulation-based learning or clinical shadowing opportunities during surgery rotations may foster practical familiarity and reduce misconceptions.

Importantly, these findings should not be interpreted as solely culturally driven. Structural factors—including healthcare costs, access to subspecialized services, and geographic concentration of care—as well as variations in health-system literacy and media portrayal of breast surgery, may also significantly influence perceptions and decision-making. Limited availability of trained reconstructive surgeons, concentration of services in tertiary centers, and financial constraints for patients remain major obstacles [39, 40]. These patterns may reflect broader workforce distribution challenges, where subspecialized services such as reconstructive surgery are often centralized, limiting equitable access across geographic regions.

Efforts to address these gaps may benefit from expanding training opportunities, improving service distribution, and enhancing awareness among both providers and patients [41, 42]. Such approaches would need to be aligned with broader health system planning to support the integration of breast reconstruction within comprehensive cancer care pathways.

Overall, these findings suggest that gaps in knowledge and attitudes among medical students are not solely educational, but may reflect broader systemic, cultural, and infrastructural factors shaping breast reconstruction delivery in Jordan.

This study represents the first attempt, to our knowledge, to systematically evaluate medical students’ knowledge and perceptions of BR in Jordan, providing a valuable baseline for future educational and policy interventions. Its strengths include a broad sampling across clinical years, as well as the use of a structured and validated questionnaire. However, limitations should be acknowledged. The cross-sectional design precludes causal inference, and reliance on self-administered questionnaires may have introduced response and social desirability bias. Additionally, although the study included students from multiple universities, the use of convenience sampling may limit generalizability. Future studies employing larger, randomly selected samples and longitudinal designs would provide more robust evidence.

Conclusion

In summary, this study highlights potential knowledge and awareness gaps regarding BR among medical students in Jordan, shaped by both educational deficiencies and sociocultural factors. Addressing these gaps through curricular reforms, cultural sensitization, and system-level interventions is essential to ensure that future physicians are equipped to counsel patients effectively and advocate for reconstructive options. Future educational initiatives may consider incorporating contextually appropriate instruction on reconstructive options while aligning training priorities with national cancer-care needs and available resources.

Authors’ contributions

Saleh Abualhaj and Mahmoud Al-Masri contributed to the conception and design of the study, provided overall supervision, and critically revised the manuscript. Lina Alshadfan, Lama M. Al-Mehaisen, Roa'a Alwarawrah, Taema Ajarma, Forat Al-Sgoor, and Yaqeen Al-Momani were responsible for data acquisition and patient record review. Yasmin Safi and Fadi Alawneh conducted the data analysis, interpreted the findings, and drafted the manuscript. Oweis Khreas, Lana Othman, and Bayan Ali performed the literature review, data validation, and assisted in manuscript editing. All authors reviewed the manuscript for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work.

Funding

This research received no external funding.

Data availability

The data underlying this article are fully available within the article itself. In addition, the datasets analyzed during the current study can be obtained from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This cross-sectional survey study was performed in accordance with the institutional research committee and the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of King Hussein Cancer Center (Approval Date: 9/2021, No: 25 KHCC 173).

The requirement for written informed consent was waived for this study, as it poses no more than minimal risk to participants. Instead, voluntary participation was ensured by including an approval statement at the beginning of the questionnaire. By proceeding with the survey, participants acknowledge that they have read and understood the study’s purpose, confidentiality measures, and their right to withdraw at any time without consequences. This approach aligns with ethical research guidelines for minimal-risk studies.

Consent for publication

Not applicable, as this manuscript does not contain data from any individual person in any form (including individual details, images, or videos).

Competing interests

The authors declare no competing interests.