But rates vary widely from state to state, and doctors worry that not all women have equal access to procedures
By Mary Brophy Marcus
TUESDAY, Feb. 18, 2014 (HealthDay News) -- More breast cancer patients are choosing reconstructive breast surgery, although where women live might influence whether they opt for it, new research shows.
"These data suggest that while a hearteningly increasing proportion of women are receiving breast reconstruction, it's not uniformly the case all across the country," said study author Dr. Reshma Jagsi, associate chairwoman of the department of radiation oncology at the University of Michigan.
According to the study, which was published online Feb. 18 in the Journal of Clinical Oncology, there was an almost 20 percent jump in reconstructive breast surgeries between 1998 and 2007 among women who'd had a breast removed due to breast cancer (a procedure called mastectomy).
Meanwhile, the number of double mastectomies, which high-risk women sometimes choose as a preventive measure against breast cancer, increased from 3 percent to 18 percent in the same period. Three-quarters of women who got double mastectomies also got breast reconstruction, the study found.
One expert had some theories on the trends.
"I think the rising number of women choosing to have [preventive] double mastectomy has gone up in part because advances in reconstructive techniques allow them to feel more confident that they will look good after mastectomy," said Dr. Oren Lerman, director of breast reconstruction at the Institute for Comprehensive Breast Care at Lenox Hill Hospital in New York City.
"The increase in percentage of women having reconstruction [after breast cancer] is probably more related to better access to information and plastic surgeons," Lerman said. "But there's still a ways to go."
Jagsi said she and her colleagues first wanted to investigate the issue because there was little information available on it since the Women's Health and Cancer Rights Act of 1998 was passed. The law says health insurers who offer mastectomy coverage must also provide for all stages of breast reconstruction.
Jagsi and her team looked at data from more than 20,000 women who underwent a mastectomy during a 10-year period. The average age of the patients was 51. Jagsi said they found that reconstructive breast surgery increased from 46 percent in 1998 to 63 percent in 2007.
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.
Mutyala said he found it interesting that the number of artificial implant procedures has gone up. "I think some of that may be the reduction in fear of silicon implants," he said. "Fifteen or 20 years ago, they had complications and side effects and there was a lot of fear-mongering about them, but slowly that perception has gone away."
Celebrities such as Angelina Jolie, who share their preventive mastectomy or post-cancer stories, are shining a brighter light on women's plastic surgery options after breast cancer too, Jagsi said. The researchers did not study that phenomenon, however.
"This is not about vanity," Jagsi stressed. "It's about physical, mental and social well being -- all of those dimensions. It can be critically important to our patients."
Visit Johns Hopkins Medicine for more on reconstructive breast surgery.
SOURCES: Reshma Jagsi, M.D., radiation oncologist, associate professor and associate chairwoman, department of radiation oncology, University of Michigan, Ann Arbor; Oren Lerman, M.D., director, breast reconstruction, Institute for Comprehensive Breast Care, Lenox Hill Hospital, New York City; Subhakar Mutyala, M.D., radiation oncologist and associate director, department of radiation oncology, Baylor Scott & White Cancer Institute, Temple, Texas; Feb. 18, 2014, Journal of Clinical Oncology, online
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