October 15, 2014 | by Nicole White
Most women who are treated for breast cancer with a mastectomy do not choose to undergo reconstructive surgery.
The reasons for this, according to a recent JAMA Surgery study, vary. Nearly half say they do not want any additional surgery, while nearly 34 percent say breast cancer reconstruction simply isn’t important to them. Fear of implants is another oft-cited factor, including worries that the implants might interfere with detection of recurrence – a fear cancer experts say is not founded.
The study also identified lack of access as a troubling issue. About 18 percent of women said they were not aware that breast cancer reconstruction was an option. Despite federal laws requiring that most group insurance plans that cover mastectomies also cover reconstructive surgery, 12 percent of women cited lack of insurance.
Laura Kruper, M.D., director of the Rita Cooper Finkel and J. William Finkel Women’s Health Center, acknowledges that many women will opt out of reconstructive surgery. However, with her patients, she stresses the importance of evaluating their options and weighing those choices very carefully.
The recent study echoes what Kruper has found in previous research: When it comes to reconstructive surgery, many women lack the access and the information.
"One of the things I am very proud of is to demonstrate in a study that there are disparities or inequalities regarding reconstruction for women undergoing mastectomy. One of my own patients early on was the inspiration: She came to City of Hope because she needed a mastectomy. The other institution said they could perform the mastectomy but the plastic surgeon could not offer her reconstruction due the fact that she had MediCal insurance."Despite laws governing insurance coverage, access to reconstructive surgery after mastectomy continues to be a problem for many breast cancer patients, Kruper adds.
"MediCal has a very low reimbursement rate, so hospitals can lose money by offering certain procedures. In 1998, there was a federal law passed which mandated that insurance companies pay for reconstruction after mastectomy. Unfortunately, even though MediCal will cover reconstruction, the reimbursement is not enough.**
At City of Hope, we are one of the very few centers in Los Angeles that offers reconstruction to all women undergoing mastectomy. One of my hopes for the future is that all women undergoing mastectomy are referred to plastic surgeons despite insurance status, race/ethnicity or income level and if they want to have reconstruction, they are able to undergo reconstruction at almost any hospital.”
Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.