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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 reconstruction.

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 functioning.

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, Ann Arbor.

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 slip.

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 than $5,000."

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."


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