Law Makes Breast Reconstruction a Right For Cancer Patients, Survivors

Health Minute

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After fighting breast cancer and having a lumpectomy or mastectomy, the cost of breast reconstruction surgery should not have to top a woman’s list of concerns.

Thankfully, a law created almost two decades ago has helped remove the stress of paying for breast reconstruction by requiring insurance companies to pay for the surgery.

Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. During the surgery, a plastic surgeon rebuilds the breast to its previous size and shape.

Plastic surgeon Todd Hicks, MD, however, worries that many women are still unaware that the law exists.

“The Women’s Health and Cancer Rights Act (WHCRA) remains one of the best kept ‘open’ secrets that too many women simply aren’t taking advantage of after enduring a lumpectomy or mastectomy,” saya Dr. Hicks.

The law – created in 1998 – requires that group health plans, insurance companies, and health maintenance organizations (HMOs) that offer mastectomy coverage must also provide coverage for some other services related to the mastectomy, the full removal of the breast.

Most women who have had a mastectomy can have breast reconstruction surgery. The surgery can help rebuild the breast’s natural shape, create a more balanced look when wearing a bra or swimsuit, and eliminate the need for external prosthesis, such as forms worm in the bra.

All stages of breast reconstruction after a mastectomy are covered under the law. If only one breast was affected by the mastectomy, surgery and reconstruction of the other breast also are covered by the law, if needed, to create a symmetrical appearance.

“One of the wonderful things about this law is that there really is no time limit regarding when the benefit is administered,” said Dr. Hicks, a Premier Physician Network’s physician. “This applies to women who have had a mastectomy years ago, but who now feel as if they are in a place – both emotionally and physically – to consider reconstruction.”

In many cases, he said, talking about reconstruction becomes easier for a woman the further she gets from her journey with cancer.

Often, it can be hard for doctors and breast cancer patients to discuss breast reconstruction in the early phases of care after diagnosis because the patient is focused on trying to beat the disease, according to a study released in the Journal of the American Medical Association Surgery.

Breast cancer support organizations advise women to discuss reconstruction options with their health care team, including oncologists, radiologists, and surgeons. 

Breast reconstruction is a process that is personal for every woman and needs a plan tailored to fit each person’s needs and desires, Dr. Hicks says. It is also important that women not let misconceptions keep them from considering the surgery.

“Women may have misconceptions about reconstruction, such as a fear that surgery will skew the accuracy of future breast screenings,” Dr. Hicks says. “It’s our hope that women will seek the advice of a professional to help direct their decisions.”

It's easy to get the care you need.

See a Premier Physician Network provider near you.