New Options for Breast Reconstruction
Experts Say Many Breast Cancer Survivors Are Uninformed About the Choices
Breast Reconstruction and Quality of Life
Research is under way to evaluate the personal impact of having breast
A new questionnaire, developed by Pusic, aims to quantify how breast
reconstruction affects the patient's quality of life.
Called the Memorial Sloan-Kettering Cancer Center Breast-Q, it measures
satisfaction and quality of life by examining body
image as well as psychological, social, sexual, and physical
It is hoped that the results will educate patients and doctors about the
value of breast reconstruction for some women, she says.
Breast Reconstruction: The Access Problem
Despite legislation mandating coverage and new techniques for
reconstruction, racial and regional gaps exist, says Amy Alderman, MD,
assistant professor of surgery at the University of Michigan Medical Center,
African-American women are half as likely to have breast reconstruction as
whites, for instance, she says.
In one study, 35% of women in Atlanta opted for immediate reconstruction but
just 8% of those in Connecticut did.
To find out why more women weren't opting for reconstruction, Alderman
searched patient data bases in Los Angeles and Detroit that included more than
2,000 women and found that providers did a "poor job in informing women
about their options."
One barrier, she says, is that many of the women didn't have access to a
plastic surgeon before their mastectomy. The Society advocates a team approach,
with the general surgeon working with the plastic surgeon.
If a woman isn't offered a team approach, the speakers say, she can first
find a plastic surgeon and ask him or her to help assemble a team.
A Patient's View
For Michele Fish, first diagnosed with breast cancer at the age of 39 in
1991, "living with just one breast was not an option." She had a
mastectomy and immediate reconstruction.
When she was diagnosed with cancer in the opposite breast in 2005, she had
another mastectomy followed by reconstruction.
"Breast cancer is enough to deal with," she says. She wanted to be
spared the embarrassment of looking "lopsided" or having a prosthesis
While insurance coverage is mandated, she says, she still had out-of-pocket
costs. "In 1991, my out-of-pocket costs were $205. In 2005, they were more
Fish says she was with the same employer and on the same health plan for
both surgeries. "There was nothing substantially different between the
surgeries. That is just how [much] health care has escalated and how much less
[insurers] are paying."