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    Most Don't Rebuild Breast After Cancer

    Rates of Reconstructive Surgery Vary Greatly Among Ethnic Groups and Regions
    WebMD Health News
    Reviewed by Louise Chang, MD

    Jan. 27, 2006 - Less than one out of five American women who have mastectomies also have breast reconstruction surgery, but cost does not seem to be the only thing driving the decision, new research suggests.

    A review of breast reconstruction practices in the U.S. found that reconstruction rates overall have not increased since 1999 -- the year legislation was enacted mandating insurance coverage for the surgery.

    Figures from the American Society of Plastic Surgeons show a 22% decline in breast reconstruction procedures between 2000 and 2004.

    Regional, Ethnic Disparities

    Despite the law, researchers concluded that reconstruction practices after mastectomy still vary greatly from region to region and among different racial and ethnic groups.

    White women continued to have the highest rates of breast reconstruction after mastectomy. Blacks, Asians and Hispanics were only about half as likely to have the surgery.

    And women living in Atlanta -- where the reconstruction rates were highest of any region studied -- were more than seven times more likely to have the surgery than women living in Alaska, where rates were lowest.

    The research was published in the Jan. 25 issue of The Journal of the American Medical Association.

    "Our study found that the law has done nothing to improve usage among women," researcher Amy K. Alderman, MD, tells WebMD.

    Alderman, a reconstructive surgeon, says there is no single explanation for why so few women have reconstructive surgery following breast removal.

    The Women's Health and Cancer Rights Act was designed to take economic considerations out of the equation by mandating that health insurers who pay for mastectomies also pay for reconstructive surgery.

    But it does not tell them how much they have to pay. As a result many plastic surgeons have stopped doing the procedure, Alderman says, because they are so poorly reimbursed.

    In an effort to assess the law's impact, Alderman and colleagues with the University of Michigan and the Ann Arbor VA Health System reviewed treatment data for roughly a quarter of the breast cancer patients in the U.S. who had mastectomies between 1998 and 2002.

    They found that only 16.5% had breast reconstruction surgery.

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