Reconstruction After Breast Cancer – No Good Choices

An article in my local newspaper makes me wake up and take notice of a real problem for women who, after breast cancer surgeries, wish to have their breast(s) reconstructed.

Mind you — we aren’t talking about breast enhancement surgery. No discussion of “boob jobs” here.

We’re talking about women who have had their breasts removed to remove cancerous cells, and who simply want to have additional surgery to reclaim as much of their femininity as they think they need to feel “whole.”

(Men — if you have trouble with this — picture losing your most manly appendage to cancer. Would you want a reasonable facsimile to replace it?)

In the United States, by federal law, a woman has a right to ask for reconstruction, and, by law, her insurance must pay for it. Sort of. Even Medicare or Medicaid must pay for it. Sort of.

The problem is, like with any medical service or procedure, these companies tell the physicians and surgeons what they will pay them, without regard to what those physicians and surgeons charge.

Think of that this way: it would be like you telling your auto mechanic what you will pay for repairs on your car, without regard to what your auto mechanic charges. Sounds like a great idea, right?

But — the problem is that at a certain price, your auto mechanic would just refuse. If you didn’t offer enough money, and if someone else offered more, then your mechanic would do the work for the person who was going to pay him more. That’s his choice.

And that’s how plastic surgeons, the ones who do breast reconstruction, look at it, too. Depending on how much cancerous breast tissue needs to be removed, the reconstruction surgery can take 5 to 11 hours. On average across the US, plastic surgeons charge $9300 per breast. Medicare and Medicaid reimburse at only $600. Is it any wonder that plastic surgeons won’t take breast reconstruction cases?

Even private insurance only reimburses a maximum of 80 percent — meaning — if both a woman’s breasts need reconstruction, then it will cost her more $5000 or more (don’t forget — the surgeon’s fee is only part of the cost. She must still pay for the hospital stay, meds, and all the other aspects.)

And some plastic surgeons will not work with private insurers either. If a woman wants the additional surgery, she needs to pay out of her pocket first ($18,600!) — and hope to get reimbursed by her own insurance later.

Of course, this becomes a very easy way to divide the haves from the have-nots…. and it made me wonder what would happen if we had a national health plan. Would it solve the problem?

Yes and no.

I looked to Canada’s national health coverage to see what the situation is there for women who want reconstruction surgery. From what I can learn, all Canadian women who choose reconstruction post breast cancer surgery can have it. It costs them nothing beyond what they are already paying into the system through their taxes — BUT — they have to wait up to two years before they get their “turn.”

And I believe the Canadian “haves” — the women who prefer to have the surgery immediately — are coming to the US to pay to have it done. Which, of course, means that those American plastic surgeons don’t have time to reconstruct the breasts of the have-nots in the US. They are busy being paid in cash by our Canadian counterparts.

The answers? No easy ones. No good choices. We Americans need to ask ourselves… is it better to pay cash and have the surgery immediately? Or is it better to wait for awhile and have it taken care of for us?

Or do we even have choices at all? I know I couldn’t afford it. Can you?