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    More Breast Cancer Patients Choosing Reconstructive Surgery, Study Finds

    But rates vary widely from state to state, and doctors worry that not all women have equal access to procedures

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    More women might be opting to have reconstructive surgery now because of the law, Jagsi said, but also because there might be more access to information about their options.

    There was "tremendous" variation in rates of reconstructive surgery across the United States, Jagsi said, and that variability reflects the density of plastic surgeons who perform reconstructive breast procedures in those parts of the country. For example, only 18 percent of breast cancer patients opted for reconstructive surgery in North Dakota, compared to 80 percent of women in Washington, D.C.

    Jagsi said it's heartening that more women are having reconstructive breast surgery after a mastectomy, but she said she's concerned about health disparities.

    "One of the take-home messages from this study is that some women simply don't have the access to plastic and reconstructive surgeons who can offer them breast reconstruction," she said. "We want to make sure there is appropriate access to this treatment for women who choose to pursue it."

    Lerman said the study delivers comforting news.

    "A study like this highlights one major thing -- that options for women undergoing mastectomy are numerous," she said. "Some of these reconstructive methods are really advanced to the point that it will make a woman look and feel normal, not just when she's wearing clothing but even when she's not. That really reassures women who are facing mastectomy."

    But there are two side of the coin, and Lerman said he's concerned about the gaps in coverage as well. "A large percentage of women are not having reconstruction, and it is probably because they simply don't have access or are not being referred to reconstructive surgeons," he said.

    Reimbursements may have changed, too, limiting women's options in some states, said Dr. Subhakar Mutyala, associate director of the department of radiation oncology at Baylor Scott & White Cancer Institute in Temple, Texas.

    "The law states that reimbursement has to occur, but what that numerical value of the reimbursement is may have decreased over the past few years," Mutyala said.

    Jagsi said the study showed several other notable trends, including a shift toward more women choosing to have implant-based surgery instead of autologous surgery, which involves using a woman's own tissue from other areas of her body. The research also showed that patients who received radiation therapy were less likely to undergo plastic surgery than those who had a mastectomy alone.

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