While breast reconstruction after a mastectomy is covered by insurers in New York, many poor, minority, and less educated women do not seek out the procedure. Now, NY Gov. David A. Paterson has signed into law a bill that is aimed at reversing this trend.
“A disproportionate number of women who are at a socioeconomic disadvantage do not get breast reconstruction surgery after a mastectomy for one of several reasons. Either they are unaware of it as an option, they do not know it is covered by their insurance programs, they do not know where to gain access to the procedures, or it is never mentioned to them by their other doctors,” said Evan Garfein, MD, the plastic and reconstructive surgeon at Montefiore Medical Center who authored the Bill.
He hopes that the new law (A10094B/S6993-B/Information and Access to Breast Reconstruction Surgery) will correct this disparity. It requires hospitals in New York to inform breast cancer patients about the availability of, and insurance coverage for, breast reconstruction before they undergo “mastectomy surgery, lymph node dissection or a lumpectomy.”
While Congress passed the Women’s Health and Cancer Rights Act in 1998, which guaranteed universal coverage for reconstruction after surgery, and New York soon passed comparable provisions into its laws, disparities in access remain.
“Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women who have been treated for breast cancer,” said Dr. Garfein. “This new law will ensure that breast cancer patients from all socioeconomic groups are informed about their options regarding breast reconstruction and about where to get the procedure.”
One-Third of Women With Breast Cancer Choose Reconstruction
Breast reconstruction is not for everyone. Each year, a quarter of a million women are diagnosed with breast cancer, according to the American Cancer Society. Of those who undergo mastectomy, 30-40 percent, depending on the study, receive breast reconstruction.
Discussing Reconstruction Before a Mastectomy is Key
Today, there are many reconstruction options for patients who have breast surgery, including saline and silicone gel implants, and several types of reconstruction using the patient’s own tissues from the abdomen, thigh, back or buttocks.
The new law underscores that patients should discuss this range of reconstruction choices before deciding between a mastectomy (the total removal of the cancerous breast) or a lumpectomy (removal of part of the breast), and that the discussion involve both the cancer surgeon, who removes the cancer from the breast, and the plastic surgeon, who would perform the breast reconstruction. The surgical team and the patient can then decide if reconstruction should be performed at all, and if so, whether that should happen at the same time as the cancer surgery (as is now the standard), or at a later date.
Many women who choose not to have reconstruction do so because of personal preferences, their overall health, the stage of their breast cancer, or to avoid the risks of additional surgery. Some women, however, don’t receive reconstruction because it wasn’t offered to them and they didn’t know to ask about it. It is this group that the legislation targets.