The struggle to require all insurance policies to cover breast reconstruction with breast plastic surgery after mastectomy was a big deal and literally required an act of Congress a little over a decade ago.

So you could call it the law of the land.

But Alicia Holt MD, a surgical fellow at the Hope Medical Center in Duarte, California, started counting heads of how many breast cancer patients in California choose breast reconstruction after their breast surgery to remove them via mastectomy.

Dr. Holt studied reconstruction rates after breast cancer surgery in California from 2003 to 2007. She saw a slight improvement, with 21.4 percent of women choosing reconstruction in ’07 while ’08 saw 29.3 percent of breast cancer patients going back under the knife for breast augmentation.

Reporting on her study at the annual meeting of the American Society of Breast Surgeons (ASBS) in Las Vegas, Dr. Holt found some limiting factors that influence a woman’s decision including:

• Insurance type
• Ethnicity
• Hospital type

Not surprisingly, Dr. Holt found women under 40 had the highest rates of breast reconstruction.

However, African-Americans were half as likely as Anglo background women to opt for breast rebuilding right away.

Patients with private insurance go in for plastic surgery breast reconstruction before women with Medi-Cal, the California health insurance program for low-income women.

Finally, patients at teaching or National Cancer Institute-qualified facilities were more likely to have breast surgery reconstruction.

According to Dr. Holt, breast cancer patients were just not getting the word that reconstruction is a right afforded them by national legislation.

One participant in the study, a breast cancer surgeon, says she  requires her patients to see a plastic surgeon, even if they have decided to forego breast reconstruction.

But Deanna Attai, MD, director of Burbank’s Center for Breast Care said another difficulty could be getting trained plastic surgeons – who normally work on a cash upfront basis – to do the procedure and accept insurance payments.

Concluded the doctors: “We need to get more information out, not only to patients but to the providers of plastic surgery.

Amen to THAT!

With over half a million U.S. women undergoing some form of breast surgery yearly, according to the American Society of Plastic Surgeons (ASPS),  plastic surgeons and others want to know exactly what makes breast surgery patients happy at the end of the day.

So five researchers from Canada, the United States and England interviewed 48 breast surgery patients, who had:

• 15 breast reductions
• 12 breast augmentations
• 21 breast reconstructions

The patients were chosen at random from the practices of four plastic surgery practices in Vancouver, Canada.

The basic task was for each patient to describe the condition of her breasts and how the subsequent surgery impacted their lives.

Results: Six themes came out of all the interviews, including:

• Satisfaction with breasts: Women who were happy with breast size, shape, symmetry, cleavage, scars, positioning, how natural the breasts look and feel and how the breasts fit the rest of the body were key concerns.
• Satisfaction with the overall outcome
• Psychosocial well-being: Patients rating high levels of well-being were pleased because, after surgery, they felt less embarrassed, more confident in social settings, more self-assured and more feminine and attractive.
• Sexual well-being: The subjects said they felt more sexually attractive when clothed and unclothed. They were more confident sexually and more satisfied with their intimate lives. Said one breast augmentation patient: “What I find now is that I am sensual, which I did not feel before.”
• Physical well-being
• Satisfaction with the process of care: Attention plastic surgeons and office staff: According to the study, breast surgery patients mainly look for the amount and quality of information they get before surgery; the actual care provided by the surgeon along with the office staff care. Responded one patient: “And once I came home, the home care…the nurses would come round and they were just excellent..”

One such area is microsurgery, operating on very tiny structures of the body through a microscope.

When women lose one or both breasts to cancer, a plastic surgeon often works with the cancer surgeon afterwards to rebuild the breasts.

Many physicians like the idea of a woman waking up from surgery and not seeing her breasts gone, with scars on her chests where her bosom used to be.

So the plastic surgeon often steps up to the table right after the mastectomy surgery.

The DIEP method takes extra flesh, fatty tissue – along with their blood supply vessels — from the woman’s stomach for use in building soft, warm, living breasts. The method is usually best for patients that need a small amount of tissue to reconstruct the breast mound or those who need both breasts reconstructed.

To get donor tissue, the surgeon uses the same incision across the binki line from hip to hip as he would in the tummy tuck procedure. Then, another curved incision is made in an arc from one side to another above the first incision.

The resulting flap — shaped like a large eye – is then moved to where the new breast will be. The long scars in the tummy area fade over time.

However, the vertical stomach muscles that create a “six-pack tummy” the rectus abdominis, are not touched.

Working at the location of the breast, the surgeon then painstakingly uses microsurgery to reconnect the blood supply to the new breast.

Then, the nipples are reconstructed from flesh on the new breast. Areolas are often created with tattoo ink. The procedure can take three to four hours.

Many patients say the DIEP (”Deep Inferior Epigastric Perforator” flap) breast is often
firmer and has a more youthful look than the natural breasts.

One 43-year-old DIEP patient wrote to her surgeon: “Not only am I cancer free, but I look much better than when I first came to you.”

Another patient wrote her surgeon after having DIEP reconstruction that, after 14 years after a divorce, she had her femininity back, had met a wonderful man and was getting married again.