Why Do So Few of Us Opt for Reconstruction?

PJ Hamel Health Guide
  • Despite the vast strides plastic surgeons have made in breast reconstruction; despite the positive outcome enjoyed by most women who have reconstruction; and in spite of the fact that federal law mandates insurance companies pick up the tab for it, fewer than 20% of women undergoing mastectomy choose to have a breast reconstruction–be it implants, or a natural reconstruction. What’s the story here?

    Part of the answer might be found in a study conducted by the University of Michigan Comprehensive Cancer Center, detailed in the March 26 edition of Cancer, a peer-reviewed journal of the American Cancer Society. In that study, 365 surgeons in the Detroit and Los Angeles metropolitan areas were surveyed as to how often they referred patients considering a mastectomy to a plastic surgeon, to talk about reconstruction. Forty-four percent of those physicians referred fewer than one-quarter of their breast cancer patients to a plastic surgeon prior to mastectomy. And only 24% of surgeons referred three-quarters or more of their patients to a plastic surgeon. So it seems the majority of women who would probably benefit from reconstruction are never even told about the possibility. No wonder they don’t opt for it!
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    What’s going on here? In the study, surgeons expressed their own theories of why women don’t choose reconstruction. Fifty-seven percent of the surgeons said reconstruction wasn’t important to patients; 64 percent said patients weren’t interested; 39 percent said they thought patients believed reconstruction would take too long; and nearly half said they believed patients were concerned about the cost.

    HELLO! Surgeons believe patients aren’t interested in reconstruction, and it’s not important to them? Translation: the choice of how you look after a mastectomy isn’t important to you. In our American society, where the breast as fashion statement has been worshipped at least since the days of Mae West? Where every little girls start wearing a training bra as soon as she can nag her mom into buying her one? Where cleavage is king, from middle school on? Or let’s talk about the fact that it takes a strong and very unusual woman to look at a flat chest and mastectomy scar where her breast used to be, and feel good about it. I’d say the majority of us are VERY concerned with how we look after a mastectomy.

    And as for the surgeons who feel their patients believe reconstruction will take too long–did anyone talk to these women about the meaning of “too long”? Obviously, reconstruction DOES take too long for a number of women, women who do hard physical labor, who could lose their jobs if they’re out of work for 2 or 3 weeks, and on light duty for several weeks after that. But for many women, spending six weeks somewhat compromised physically, in exchange for a lifetime of looking “normal” in your clothes? No contest.

    Finally, it’s absolutely unacceptable that in this day and age any woman with health insurance believes that reconstruction is too expensive. The Women’s Health and Cancer Rights Act of 1998 provides that insurance companies must cover the cost of reconstruction (or prostheses) for women having a mastectomy–both for the affected breast, and for the opposite breast to achieve symmetry, if necessary. For women without health insurance: yes, cost is a HUGE concern, and an obvious barrier to reconstruction. But for those with health insurance, it shouldn’t be an issue; and that information should put on the table right up front, in any discussion of reconstruction.

  • The study concludes by noting that another part of the issue may be the limited availability of qualified plastic surgeons in underserved areas of the country. Understandably, few surgeons will suggest breast reconstruction to patients when there’s not a plastic surgeon who can perform that reconstruction within a hundred miles. But when reconstruction IS a possibility, and it’s not presented as a serious option to a woman about to undergo a mastectomy: that’s a crying shame. In this case, what you don’t know WILL hurt you. 
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    For more information, please visit our breast reconstruction page.
Published On: April 09, 2007