Access To Breast Reconstruction

By Peter Henderson, MD

Access is one of the most fundamental aspects of breast reconstruction; namely, if you unfortunately develop a situation where you would potentially benefit from it, are there easy ways for you to learn that it exists, obtain information about what the different options are, and become connected with a surgeon who is willing and able to perform whatever you choose from the full range of reconstructive options?

Breast reconstruction - pink ribbon

Historically, the answer has often been “No” to all of these questions.  Fortunately, a federal law has passed in 1998 that requires breast reconstruction procedures to be covered by all insurers.  This is great, but it does not address every issue that keeps breast reconstruction from being able to easily accessed at all times.  Instead, we still have a long ways to go.  While there is no simple answer to why we are not there yet, there are regional, demographic, and legislative reasons that in part explain why.

Regional disparities

There is clear disparity between who has access to information and capable surgeons.  While Western countries, and the United States in particular offers better access than the rest of the world, there are significant disparities within the United States, as well.  Multiple studies have shown that rural areas are less likely to have as many surgeons who perform these sort of procedures. 

Demographic disparities

As is unfortunately true in many aspects of medicine, and society more broadly, there are significant disparities in access to breast reconstruction procedures related to demographic differences.  Minority groups in the United States are less likely to have information available to them in a language and format that is most familiar to them.  And based on insurance status, neighborhoods, and other social determinants of health, members of minority groups are less likely to be able to be seen by a surgeon who can provide the necessary services.

Legislative disparities

Despite the federal law requiring coverage, there is still significant disparity between states in terms of what exactly is covered, and how it can be accessed.  For instance, New York State recently passed a law requiring that “aesthetic flat closure” and other forms of non-breast chest reconstruction (for those women who choose that approach) be covered by all insurers.  This is a significant step forward, and hopefully will serve as a model for other states.

Access to breast reconstruction concepts and services are improving, and for that we should all we pleased.  But there is still so much more that needs to be done in order to increase access for everyone, and to close the gaps based on regional, demographic, and legislative disparities.  We recommend further harnessing the immense power of the internet for information dissemination, support, and activism to bring the spotlight onto this important issue – the brave women who are forced to face this terrible disease and the consequences of treatment deserve absolutely nothing less!

Peter Henderson

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