In 1998, then President Bill Clinton signed into the law the Women’s Health and Cancer Reconstruction Act (WHCRA). The intention of this bill was to ensure than patients who underwent mastectomy for the treatment of breast cancer would be able to have access to reconstruction through their insurance plans.
Previously, many insurances did not cover reconstruction after breast cancer surgery because it was considered ‘cosmetic’ surgery. Many patients thought this as well, and as a result, avoided undergoing reconstruction. The law was supposed to rectify that situation, but as of 2012 the National Cancer Institute reports that only about 20% of breast cancer patients receive reconstruction.
Why is that? The reasons are complex, and involve a combination of things.
When a patient is diagnosed with breast cancer, it is often stressful and emotional, as anyone might expect, and often the foremost concern is getting rid of the cancer—not how they will look afterwards, which I understand. Treatment of cancer dominates the practical approach to cancer, and rightly so. Without a cure, there is no reconstruction.
As a result, reconstruction is generally regarded as a ‘secondary’ procedure and not part of the ‘primary’ aim of treatment, which is, of course, curing the cancer. So, even in spite of a government mandate that provides insurance coverage for the process of breast reconstruction, this is apparently not enough to influence the practical approach both doctors and patients.
But I argue, having performed many breast reconstructions, that part of the cure also entails making a patient feel whole again, and for many women (although not all) this entails reconstruction, or at least the opportunity to pursue it, if so desired.
A 20% reconstruction rate suggests that breast reconstruction after cancer surgery is not always given the place it really deserves in the treatment of cancer because it is still considered secondary, optional, or not that critical to consider initially.
But to be fair, there are also other considerations as well, which are important, the most important being is that often breast cancer reconstruction involves as heavy commitment of time, and often multiple surgeries to achieve its results. This is not all that appealing to someone who has gone through the stress and worry of cancer surgery followed by a course of chemotherapy and/or radiation, which is understandable. After all, who wants to go through a time consuming and stressful process right after they have gone through a time consuming and stressful process?
And finally, there is, whether people like to admit or not, a sense that breast reconstruction is sort of a ‘vain’ undertaking. Beating cancer takes courage, and part of courage is humility and thankfulness, which seem at odd with wanting to make yourself look better.
I don’t agree with this perception, but it is a real phenomena which I have observed personally in my practice. Consider it for a moment. Imagine you are a young woman, and perhaps you have children, and you have just fought and survived through breast cancer. Your perspective on what is really important may change as a result of the experience you just had, and now, the investment of time and effort that is necessary to have a reconstructed breast in order to make yourself look and feel better may not be as important to you as spending time with your loved ones. Likewise, if you are an older woman, you may think something along the lines of: what would I need a breast later in my life?
But undergoing reconstruction of the breast after cancer surgery is not a vain or self-centered pursuit by any means. Once again, beating cancer takes great courage, and indeed, humility and thankfulness are integral parts of courage, but so are feeling confident, whole, and strong, which breast cancer reconstruction can help provide for many patients.
That being said, ultimately what is most important is a patient’s wishes, and yes, sometimes delaying or forgoing breast cancer reconstruction altogether is the best step that can be taken for some of the reasons that I have previously mentioned (ie stress, family, time commitment, etc.)
Still, a 20% rate of breast reconstruction is awfully low, and it suggests something more to me than people don’t want breast cancer reconstruction because they are too tired after cancer treatment or think that the process is somewhat vain. It suggests a lack of information, and it is an important reason why I believe that even if you have no intention of every undergoing breast reconstruction, you should talk the time to inform and educate yourself about the option in detail through a consultation with a board certified plastic surgeon.