From the July 2016 issue of HealthCare Business News magazine
By Scott Dodson
Each year, approximately 230,000 women in the U.S. are diagnosed with invasive breast cancer. According to a recent assessment from the Agency for Healthcare Research and Quality, the rate of women undergoing mastectomies increased 36 percent between 2005 and 2013, and double mastectomies more than tripled. With more women than ever choosing a mastectomy, it’s critical that they be educated about their right to breast reconstruction.
Since passage of the Women’s Health Care and Cancer Rights Act in 1998, health plans that offer breast cancer coverage are required to provide coverage for breast reconstruction and prostheses. Sadly, less than half of all women requiring a mastectomy are currently presented with that option. The American Society of Plastic Surgeons puts the overall rate of breast reconstruction among women who have undergone a mastectomy at well below 25 percent. A recent JAMA study found that one in five women who did not undergo breast reconstruction reported a lack of knowledge about the procedure.
Across the health care system, it’s time to ensure women are informed of all their options.
The Breast Cancer Patient Education Act, passed by Congress in December 2015, requires the Department of Health and Human Services to implement an education campaign to inform breast cancer patients about the availability and coverage of breast reconstruction and other available alternatives post-mastectomy.
There are several types of breast reconstruction procedures which can be considered by the patient and her surgeon. These typically fall into one of three categories:
• Tissue flap procedures, which involve tissue and skin taken from other parts of the body and used to rebuild a breast.
• Direct-to-implant surgery, which is when the surgeon places an implant under the post-surgical skin envelope following mastectomy (without expanding the tissue as an initial step).
• Breast implants via tissue expanders, which is the current standard of care. Approximately 70 percent of women who opt for reconstructive surgery have “tissue expanders” implanted to help prepare a “pocket” or space for long term breast implants. Tissue expanders help the body “grow” extra skin and tissue. Once the skin and tissue have been sufficiently stretched, the temporary tissue expander is surgically removed and a long-term breast implant is placed in the pocket.
Although tissue expansion has been practiced successfully for decades, standard saline-filled expanders have limitations. Women must undergo a series of saline injections in the physician’s office to inflate the expanders, a process which is reported to be uncomfortable, inconvenient and lengthy. The treatment of breast cancer and the reconstruction process is grueling, time consuming and costly. Women who do not opt for breast reconstruction may be dissuaded by fear of the process and the protracted length of time to complete the reconstruction.
