Breast Cancer & Breast Reconstruction

One in eight women will be diagnosed with breast cancer during their lifetime. Of the roughly 100,000 women in the Kentucky Purchase Region, 13,000 have had, currently have, or will have breast cancer. An estimated 200 new cases will be diagnosed in the region in 2021 alone. This is a journey that no one chooses to take but, nevertheless, many are forced to embark on.

Breast reconstruction is an element of breast cancer treatment that can produce profoundly positive effects even in the midst of this profoundly difficult experience. It has been shown to improve psychological, social, and physical wellbeing. Every woman who faces the diagnosis of breast cancer should, at the very least, have the opportunity to learn about reconstruction and explore the options available to her.

Barriers to Breast Reconstruction

There are many reasons why women do not undergo breast reconstruction. For some, forgoing reconstruction is an intentional, personal choice—one that should be respected. For many others, however, forgoing breast reconstruction is not a choice at all but rather the result of unfortunate circumstances.

Three of the most common barriers to breast reconstruction are (1) misunderstandings about the cost and coverage of reconstruction, (2) misperceptions about age in relation to reconstruction, and (3) proximity of patients to a reconstructive surgeon.

Insurance Coverage of Breast Reconstruction

Breast reconstruction is covered by insurance—a simple statement that all breast cancer patients should hear. I am amazed by the number of people who do not know this, and I have lost count of how many times I have seen relief wash over a patient’s face when she hears those words. The Women’s Health and Cancer Rights Act of 1998 mandated on a federal level that any group insurance plan that covers breast cancer surgeries must also cover breast reconstruction surgeries. This mandate has no time constraints or expiration date. Whether a patient is pursuing immediate reconstruction at the time of breast cancer surgery or is interested in reconstruction twenty years after she had a cancer removed, the procedure will, in all but the rarest of circumstances, be covered by insurance.

Age and Breast Reconstruction

“I’m too old to worry about breast reconstruction.” I could not begin to guess how many times I have heard that sentiment expressed. For some women, this is a sincere conviction, but, for others, it is a simple misperception, one that unfortunately discourages them from pursuing a treatment that could benefit them tremendously.

There is no age limit for breast reconstruction. There is, to put it another way, no age above which a woman is by default “too old” for reconstruction. Although it is true that the likelihood of having medical issues that could preclude an individual from being a good candidate for surgery increases with age, age itself is never a barrier to breast reconstruction. Furthermore, the psychological, social, and physical benefits of breast reconstruction have been demonstrated to accrue regardless of how old the patient is.

Breast Reconstruction and Proximity to a Reconstructive Surgeon

Numerous studies show that the farther a patient must travel for breast reconstruction, the less likely she is, ultimately, to undergo a reconstructive procedure. One such study recently revealed that patients who must travel over 20 miles to receive reconstruction are 30% less likely to pursue this option than those who don’t. This disparity only increases with greater distances. The opportunity to reduce these distances and decrease these disparities is one of the reasons it is such an honor to bring breast reconstruction services to the Purchase Region.

Having to travel many miles and several hours to see a board-certified plastic surgeon often leaves women with a very difficult choice: forgo reconstruction altogether or undergo reconstruction in the care of an individual who has no formal training to perform it. It is my sincere hope that no patient in the Purchase Region ever faces this dilemma again.

Breast Reconstruction by a Board-Certified Plastic Surgeon

Simply put: other than plastic surgery, there is no surgical residency in which a resident is comprehensively trained to perform breast reconstruction. Furthermore, other than the American Board of Plastic Surgery, there is no board certification process that formally evaluates candidates on their understanding of and competency in performing breast reconstruction. Any surgeon who is not a residency-trained, board-certified plastic surgeon but nevertheless performs breast reconstructions is operating without any certifiable proof that he or she is even remotely qualified to do so. Patients may encounter surgeons hoping to obscure their lack of qualifications by claiming to have obtained certification through “additional training” or “special courses.” Such statements are red flags.

The Breast Cancer Surgeon and the Reconstructive Surgeon

Any woman navigating the journey of breast cancer who chooses to undergo breast reconstruction will have two surgeons involved in her care: the breast cancer surgeon and the reconstructive surgeon. It is crucial that these roles remain separate. Under no circumstances should both be filled by the same surgeon. Merging these roles creates an immediate conflict of interest, which is why it is a practice frankly scorned by reputable cancer centers.

The Goal of The Breast Cancer Surgeon

The goal of the breast cancer surgeon is to treat cancer by surgically removing breast tissue. This should be the surgeon’s singular focus, and that focus should dictate any and all surgical decisions he or she makes. Sometimes these decisions are difficult ones, like when a surgeon must remove more tissue than originally expected or intentionally induce injury to the breast skin in order to fully resect the affected tissue. Any other consideration that might skew these decisions could be detrimental to the patient.

The Goal of The Reconstructive Surgeon

The role of the reconstructive surgeon is to accept the tissue conditions present after the cancer has been removed. The reconstructive surgeon, of course, hopes for the best conditions possible, including generous flap thickness, favorable blood flow, and adequate breast skin to accomplish closure, but he or she knows that circumstances are frequently less than ideal. The reconstructive surgeon has no say in determining what the starting conditions of a breast reconstruction will be but must be prepared to make the most of them regardless.

With these distinctions in mind, it should be clear why two surgeons, not one, must be involved in this process. The surgeon assessing how much tissue is medically necessary to remove must not factor into such decisions whether it will make the reconstructive surgery easier or more difficult to complete. But, if the cancer surgeon and the reconstructive surgeon are the same individual, it is impossible to avoid doing just that—even if only subconsciously. This inevitable conflict of interest is why many medical professionals, including myself, feel strongly that a single-surgeon arrangement is unethical.

Breast Reconstruction and the Board-Certified Plastic Surgeon

The undisputed standard of care in breast cancer treatment is that every patient is offered a consultation with a plastic surgeon. This is the practice of cancer centers nationwide. Many states, in fact, are pursuing legislation that would legally require all breast cancer patients to be offered a consultation with a plastic surgeon to discuss breast reconstruction options. Such consultations are an integral part of breast cancer treatment—not a superficial addition or a luxury.

The message I would like to send to women faced with this life-changing diagnosis is this: “You are in control of your care, even when you feel like you are not.” Knowledge is power, and it is your right to demand that you receive the best care possible. If you are receiving breast cancer treatment at an institution that does not by default include a referral to a plastic surgeon to explore your reconstructive options, request one. Or take it upon yourself to seek one out.

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(270) 709-1984

2605 Kentucky Ave., Suite 100 Paducah, KY 42003