Submitted by Dr. Frank J. DellaCroce, ITC Advisory Board Member and MD, FACS, from the Center for Restorative Breast Surgery, New Orleans, LA www.breastcenter.com
For women who’ve been diagnosed with breast cancer, the emotional blow of mastectomy and the sense of loss that comes with it can leave scars that go far beyond the surface. The daily reminders in the mirror, brought by the empty, scarred chest, can leave a profound feeling of injury long after the treatments are over. Fortunately, modern plastic surgery can close this circle with sophisticated techniques that can sometimes even leave things more beautiful than before the breast is removed.
Protecting or restoring symmetry with reconstructive techniques makes dressing easier and eliminates the hassle of a bra prosthesis. Reconstructive procedures that use living fat transplantation have even been shown to help reduce lymphedema symptoms. The positive impact of providing hope and relief from the fear of disfigurement has been well documented in the breast reconstruction literature and a recent report from the American Society of Plastic Surgeons reinforces the safety of immediate breast reconstruction. The study also showed that reconstruction didn’t increase complications or cause delays in cancer treatment.
Federal legislation under the Women’s Health and Cancer Rights Act, passed in 1998, guarantees women the right to coverage of breast reconstruction by health insurers and a number of states have reinforced this with laws of their own. Despite the health, psychological, practical, and social benefits of breast reconstruction and the guarantee of coverage from health insurers, only a fraction of women who are eligible for breast reconstruction at the time of mastectomy pursue it. Even more surprising is the fact that African American, Hispanic, and Asian women undergo breast reconstruction at HALF the rate of all women in the affected population.
A number of studies have examined why this disparity exists. Some reasons may include the fact that black and Hispanic women are often diagnosed later and at more advanced stages than white women of similar age. As a result, more minority women die of their disease and if they don’t have reconstruction at the time of their mastectomy they aren’t able to pursue it later on.
Other reasons reported include a fear of implants and their safety, or that reconstruction might interfere with cancer detection. Studies prior to the passage of the Affordable Care Act indicated a barrier due to lesser numbers of minority women possessing private health insurance. Plastic surgery may be perceived as a luxury and as being cost prohibitive for those who haven’t benefited from proper information regarding breast reconstruction and its mandated coverage by health insurance companies.
Study after study has validated this information delivery problem and its impact on women facing mastectomy. Women are often not adequately informed by their doctors of the modern options for breast reconstruction. A report by the American Society of Plastic Surgeons revealed that 7 out of 10 women battling breast cancer are never properly counseled regarding their options for reconstruction. This information gap also includes lack of information delivery on whether the breast can be rebuilt on the same day the mastectomy occurs (see Figure 1, below). The reasons for this are unclear, but evidence of significant between-surgeon variation in the discussion of reconstruction may leave women with a feeling that breast reconstruction is out of their reach or that it automatically comes at a later time after mastectomy (see Figure 2).
This disparity in information delivery seems to be even more of an issue for minority women. This may explain, in large part, the associated imbalance in the numbers of minority women who undergo breast reconstruction compared to other women of similar age and disease stage. So, the biggest factor that likely leaves minority women in the shadows, is the poor delivery of information to them by the health care providers who are charged to their care. We have much work to do. Most of it needs to be centered on efforts to provide effective, reliable, and accurate information regarding what is available to rebuild and restore a breast lost to breast cancer. Room exists, even more notably, in the area of improvement of information delivery to minority women on the safety of reconstructive options and the overall benefits that breast reconstruction can provide.
Fortunately, most women today have access to the internet and can empower themselves by studying what is available to them on their own. Combining that knowledge with the opinions of one or more well-experienced plastic surgeons gives today’s woman the advantage of knowing that breast reconstruction can almost always be done for her on the day of the mastectomy, that implants are safe, and that there are even techniques that can use living fat transplantation to rebuild her breast with a natural solution for permanent restoration of wholeness.
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