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    Why Some Breast Cancer Patients Forgo Implants

    Not All Women Follow Mastectomy With Breast Reconstruction

    Economics, Hospital May Influence Choice to Have Breast Implants

    Kruper says many non-teaching hospitals may not have plastic surgeons on staff to perform reconstructive surgery, particularly if women want it months after mastectomy.

    So-called "delayed reconstruction" was offered only at a limited number of hospitals in the four-county area, and its availability rose only slightly over the course of the five-year study, she says.

    Economics may be another important factor, Kruper says. "The shortage of plastic surgeons willing to accept Medi-Cal’s lower reconstruction reimbursement rates likely limits the ability of these patients to undergo reconstruction when desired," she says.

    One of the major drawbacks of the study is that women were not asked whether they voluntarily forwent breast implants or whether it wasn't offered.

    Patient Preference Influences Breast Implants

    ASBS spokeswoman Deanna J. Attai, MD, of the Center for Breast Care Inc., in Burbank, Calif., says that in some areas, particularly rural regions, it may be difficult to find plastic surgeons trained in reconstructive surgery.

    But, she says, "sometimes it's patient preference. I am continually surprised at the number of women, younger women, who feel it is just not important to them. It really is an individual issue," she tells WebMD.

    John Corbitt Jr., MD, a private practitioner in Palm Beach County, Fla., was completely surprised at the study's findings.

    "In my practice, closer to 90% or 95% of women opt for reconstruction," he says.

    Nipple-Sparing Mastectomies Seem Safe

    At the meeting, Corbitt presented a study of nipple-sparing mastectomies. The procedure is just what its name implies: intricate surgery to preserve the nipple and the areola after mastectomy.

    "For years, the nipple was removed because there were worries the breast tissue it contained had breast cells with the potential to become cancerous," he says.

    Once considered experimental, nipple-sparing mastectomy has become common enough that the ACSM is starting a registry to ensure women who have it fare as well as women who don't, Attai says.

    In Corbitt's small study, one of 228 procedures resulted in a recurrence of cancer in the nipple. "So we simply went in and removed it, and the patient had no cancer.

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