Here at Orlando Cosmetic Surgery, we are fortunate to be centrally located in our state and in a major metro-area where many mastectomy patients have access to Dr. Orlando Cicilioni’s breast reconstruction expertise. “Breast reconstruction has been shown to improve body image and self-esteem when compared to no reconstruction.” Yet, even as the new the year begins, we have recently become aware that the art and science of breast reconstruction is not offered in many small community hospitals.
“Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.” Yet many women deny themselves this important surgery. In fact, a recent study has proven that long distance travel to a physician capable of fine breast reconstruction surgery after mastectomy has become an obstacle for some women.
We know such patients genuinely need the surgery for closure from their cancer ordeal and self esteem as they pursue life after cancer. This issue was addressed in a recent issue of Plastic and Reconstructive Surgery, which featured a revealing new study concerning breast reconstruction.
By definition, “Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. The surgery rebuilds the breast mound to match the size and shape of the other breast. The nipple and the darker area around the nipple (areola) can also be added.”
Keep in mind that the Women’s Health and Cancer Rights Act (WHCRA) of 1998 legislatively mandated insurance payor coverage of breast reconstruction after mastectomy and this has resulted in more women getting their reconstructions completed. The largest group selected implant-based reconstructions, although an increase in autologous breast reconstructions has also been noted.
Research on the relationship between travel distance and breast reconstruction was recently conducted by Evan Matros, MD, and his team at the prestigious Memorial Sloan Kettering Cancer Center, New York.
They studied more than 1 million US women undergoing mastectomy from 1998 to 2011. During that time period, the overall rate of immediate breast reconstruction approximately tripled: from 10.6% in 1998 to 32.2% in 2011. This was proof that more and more women are becoming aware of the benefits of breast reconstruction and taking advantage of their insurance options, but what obstacles remained in the way of those who did not have their breast reconstruction?
They stated “While greater patient awareness and insurance coverage have contributed to greater breast reconstruction rates in the United States, geographic barriers to access this service remain, particularly to academic centers.”
Matros and his team reported, “Patients who underwent mastectomy with immediate reconstruction had to travel significantly greater distances than patients who did not undergo reconstruction.”
Travel and Reconstruction Statistics
Let’s take a look at some of the statistics in the study. Breast cancer reconstruction was performed in about 14% of women who traveled zero to 20 miles for breast cancer treatment. On the other hand, nearly 25% of those traveling 100 to 200 miles received breast cancer reconstruction surgery.
During this same time period, the distance traveled increased by 2% per year. Women who did not choose reconstruction did not travel or increase travel time more when they chose only basic mastectomy surgery.
The study also revealed that reconstruction rates depended on the type of hospital facilities chosen by the women. The statistical break down looked like this:
1. 10% of women treated at community hospitals got their reconstruction.
2. The number doubled to 20% at comprehensive community hospitals with more services.
3. 26% of the mastectomy patients that used academic (university-affiliated) hospitals got their reconstructive surgery.
How Far Will Women Go?
So, the research scientists wanted to discover just how far away from home a patient would travel for either mastectomy or mastectomy plus reconstruction.
A. In the study group, the research scientists found that average travel distance was about 20 miles for the two groups of community hospitals.
B. Women traveled 47 miles for surgery to the academic hospitals.
C. Then the statistics took an interesting turn. The scientists discovered, “Travel distance to high-volume hospitals performing autologous reconstruction more than doubled: from 22 to 53 miles.”
The researchers deduced the reason for this was the high concentration of specialized centers in metropolitan areas.
The Breast Cancer Reconstruction Research Conclusions
It is obvious that geography has increasingly become a key contributor to unequal healthcare access.
This is an important source of variation in healthcare outcome. Matros and colleagues concluded, “The greater distance was traveled by women undergoing breast reconstruction, as compared to mastectomy without reconstruction, suggests the presence of a geographic disparity.”
In the final analysis, the researchers declared “that measures providing insurance coverage—such as the WHRCA and the Affordable Care Act—will not be sufficient to eliminate barriers to accessing breast reconstruction after mastectomy.” By the way, you can read more about this breast reconstruction study at this reliable online resource
Sadly the statistics forced their conclusion that “Greater numbers of plastic surgeons, especially in community [hospitals], would be one method of addressing this inequality.”
That, unfortunately is a long range answer requiring extensive planning.
Until then, Orlando Cosmetic Surgery continues its policy of extending a welcoming hand to mastectomy patients from all communities. Keep in mind that “Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.”
If you have had a mastectomy in the past, or if you are planning one, please feel free to call for your very personalized, custom consultation.
Discover the many new options and available advanced techniques in breast reconstruction with Dr. Orlando Cicilioni.
Here at Orlando Cosmetic Surgery, we do not want you to feel like you must be a resident of Orlando in order to be our patient. We have enjoyed helping mastectomy patients from all parts of the United States. We continue our pledge to help mastectomy patients who travel from across town, across Florida and all the way across the country. Be sure you visit our special Orlando Cosmetic Surgery website page concerning breast reconstruction surgery.