[ PRINT ] [ Printing FAQ ] About OncoLink Editorial Board Sponsors Help See Today's OncoTip Usage Statistics Virtual Classroom Abramson Family Cancer Research Institute "Confronting Cancer Through Art" is an exhibition by people whose lives have been touched by cancer. This week we are featuring artwork by: Jacqueline Kniewasser Pontypool, Ontario Visit the Children's Art Gallery This week's artwork was donated by a pediatric cancer patient who received treatment for cancer at The Children's Hospital of Philadelphia.

Nurse Notes: Reconstruction After Breast Surgery - Personal Choice or Federal Case? Author: Maggie Hampshire, RN, BSN, OCN, with special commentary by Dr. Don LaRossa, Professor of Surgery in the Division of Plastic Surgery at the University of Pennsylvania Affiliations: University of Pennsylvania Cancer Center Posted Date: February 1, 1998 Last Revision Date: Sunday, 14-Feb-1999 13:54:27 EST Copyright © 1994-1999, The Trustees of the University of Pennsylvania Every year, a significant number of women with breast cancer must undergo mastectomy in order to treat their malignancy effectively. The breast can play an important role in the self- image of all women. To some women, the loss of a breast due to cancer may mean the loss of part of their identity. Reconstruction of the amputated breast can be the beginning of a physical and emotional restoration to many women. According to Dr. Don LaRossa, Professor of Surgery in the Division of Plastic Surgery at the University of Pennsylvania, "The biggest benefit to reconstructive breast surgery is restoring a woman's sense of wholeness." Breast cancer affects all women differently. Every woman should be afforded the choice of undergoing reconstruction as part of her breast cancer treatment, and should be provided with the adequate facts to make an informed decision. The benefits of reconstruction should be discussed soon after the diagnosis of cancer. Today, almost any woman who has her breast removed due to cancer may be able to have it rebuilt through reconstructive surgery. In fact, there are several reconstructive options available after mastectomy. Your general surgeon and plastic surgeon should make an individualized recommendation based upon your age, health, goals, anatomy, disease stage, tissue type, and treatment options. There are a number of circulating myths and half-truths about breast reconstruction after a breast cancer diagnosis. For example: having to wait up to one year to safely undergo reconstruction; reconstruction makes it difficult to identify cancer if it recurs; reconstruction interferes with cancer treatments. These simply are not true in all cases and are destructive to the patient's critical decision-making ability. These misconceptions make it extremely difficult for a woman to weigh all the options available while she is struggling to cope with the initial shock of the diagnosis of her cancer. That is why it is critical for the general surgeon or breast surgeon to discuss the option of reconstruction immediately after diagnosis and include it as part of the treatment plan. Unfortunately, many women are not presented with the options or even the information they need to make an informed decision about reconstruction. Many of these women live without reconstruction simply because of unfounded fear and lack of information. According to Dr. LaRossa, the women in his practice who have chosen not to undergo reconstructive procedures after losing a breast to mastectomy have many reasons for doing so. Dr. LaRossa states that, "...often women feel that they have had enough surgery and do not want to submit themselves to further operations." Also, Dr. LaRossa has found that, "More often than not they are women in the older age group who say they are not as bothered by the loss of the breast." Sometimes, the cost of the operation is prohibitive. Although Dr. LaRossa has not seen this as a barrier, perhaps due to the fact that many of his patients are fortunate enough to come from the Pennsylvania and New Jersey area where state legislation has improved this problem. However, Federal legislation to require insurance companies to cover breast reconstruction is still necessary because 37 states do not have such laws. In addition, 70 million Americans receive health benefits through federally regulated, self-funded plans which are not covered by state insurance mandates. The American Society of Plastic and Reconstructive Surgeons (ASPRS) conducted a survey which found that board-certified plastic surgeons across the country had problems obtaining insurance coverage for all stages of reconstruction. This survey found that 84% of the surgeons questioned had as many as 10 patients who were denied insurance coverage for reconstructive surgery made necessary by a mastectomy. Since there were 85,000 mastectomies performed on American women in 1995 alone, there are huge numbers of women who are being denied coverage for reconstructive surgery each year. Many people, including myself, are wary of more federal regulations, especially those which effect such personal choices in our lives. However, given the above statistics, I personally do not see another option. Women need to know that breast reconstruction after mastectomy is available. Dr. LaRossa agrees, "I do feel that legislation such as the Reconstructive Breast Surgery Benefits Act of 1997 (H.R.164) is, unfortunately, necessary. Insurance companies have not uniformly accepted breast reconstruction as part of the complete treatment of the patient with breast cancer. The decision should be left up to the patient of course, but the options should be available." Most insurance carriers will pay for prosthetic eyes, hips, and nasal reconstructions after tumor incisions. Similarly, breast reconstruction is a reconstructive, not cosmetic procedure. Dr. LaRossa explains that, "Many insurance carriers will cover the cost of breast reconstruction, although only a few, will cover the cost of surgery on the opposite breast. I feel that restoring symmetry to the other breast should be included in the legislation as well. We define cosmetic surgery as surgery that is used to improve the appearance of an already normal structure. While reconstructive surgery seeks to restore a normal appearance to a structure that is otherwise rendered abnormal by birth, surgery, or disease. In many areas this becomes a very clear distinction. However, in the breast, one might argue that the remaining breast is an otherwise normal structure. However, the breast is a paired organ and it is impossible to judge the appearance of one breast in isolation. Therefore, to provide a complete restoration, both sides may need to be treated." The Reconstructive Breast Surgery Benefits Act of 1997 (H.R. 164) guarantees insurance coverage for all stages of reconstructive breast surgery resulting from mastectomies. Unfortunately, in too many cases, insurance companies refuse to pay for reconstructive breast surgery because they feel it is unnecessary. This legislation will attempt to end this type of discrimination against the female breast for reconstructive coverage. For many women, breast reconstruction surgery after a breast cancer mastectomy marks the end of their treatment phase and the beginning of new lives as cancer survivors rather than cancer patients. Studies have documented a what I have observed in my own practice as an oncology nurse. Fear is a leading reason why many women do not participate in early breast detection programs. In many cases, the fear is not concerning the actual diagnosis of cancer or the treatments. These women fear losing their breast. If breast reconstruction were more accessible as a viable and affordable option, more women might participate in early detection programs. This could translate into a lower mortality rate from breast cancers. More federal legislation needs to be approved. Efforts such as these must be made to increase the public awareness that a breast cancer diagnosis does not necessarily mean the loss of your breast. And if a mastectomy is necessary, the loss of your breast does not mean the end of your life.

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