How did we get into this mess?
Our thoughts on limited access to DIEP flap reconstruction
You didn’t ask to be diagnosed with breast cancer or have a genetic mutation.
If it were up to you, you’d probably choose to never NEED to have breast reconstruction altogether. But the reality is that women are being diagnosed with breast cancer more and more these days. It is now the leading cancer type being diagnosed in women. Therefore many surgical techniques and treatments have evolved to meet the demand and provide the best care to women. Thank God for physicians, surgeons, nurses, and all healthcare providers who have made it their mission to help you with your cancer diagnosis.
Women deserve options & ACCESS to them.
Women undergo mastectomies every day…amputations. A surgery that removes cancer (and risk for cancer), but also takes a big part of who you are. The silver-lining to having to undergo a mastectomy is access to breast reconstruction. You have options, many options at that. You can stay flat and seek aesthetic flat closure. You can opt for implants. Saline or silicone? Above or below the muscle? You can opt to go smaller or larger than you were before. Now thanks to modern medicine, you can also use your own tissue in the form of a free flap to reconstruct your breast. Very commonly, women choose to have DIEP flap reconstruction. This surgical technique takes fatty tissue from your lower tummy, some skin and blood vessels to fully reconstruct your breasts with 100% of your own tissue. Whether a woman chooses to stay flat, use implants or their own tissue for breast reconstruction, they should have equal access to all their options.
So what is DIEP flap reconstruction?
The DIEP flap surgery is a form of breast reconstruction that uses abdominal fatty tissue, skin and blood vessels to reconstruct the breast post mastectomy. This technique spares your abdominal muscles, meaning once you have healed from your breast reconstruction, you can gradually get back to your normal lifestyle (assuming you had little to no complications). Once cleared by your surgeon, you can do sit-ups, or even run a marathon if you wanted. Before this surgery existed, women were being offered a technique called a TRAM flap or implants. The TRAM flap takes ALL of your abdominal muscles, comes with associated complications, and the recovery can be brutal. We have cared for women who have had previous TRAM flaps and they lack all abdominal wall strength. They depend on support from internal mesh placement, girdles and garments since their muscles have been transferred to their chest as part of their reconstruction. The human body strongly depends on core strength for our daily activities, and what a shame to think that type of surgery was ever permissible. Thankfully, the TRAM flap evolved into the DIEP flap that is muscle-sparing. In the hands of a skilled microsurgeon, complication rates can be low and quality of life after recovery high. There are also other types of free flaps that are utilized for breast reconstruction, but often times we saw that the DIEP flap was the patient’s best option.
In what scenarios may DIEP flap be the best option?
Keeping in mind that implant-based reconstruction is a great option for many women, there are many reasons why using your own tissue for breast reconstruction versus using implants is beneficial. Here are few examples:
If the woman has autoimmune issues, she may strongly be against placing a foreign body in her chest area, which can run the risk of her body rejecting the implants.
Many women have done ample research on implants and have learned of BII (Breast Implant Illness) and associated issues as well as cancers that can develop like ALCL (Anaplastic Large Cell Lymphoma).
A big reason why many women choose to use their own tissue for breast reconstruction is if radiation is part of their treatment plan. Radiation effects on an implant reconstruction can cause complications like severe implant contracture, internal scarring, and long-term skin changes like: lack of elasticity, tethering and running the risk of wound breakdown.
Every scenario is different, but always be confident to ask your doctor questions to make sure you are making the best decision for your body.
So how is access to breast reconstruction being limited?
Medicare and private insurance companies are taking away service codes that surgeons utilize for reimbursement for DIEP and other types of free flap breast reconstructions. Instead, they are directing surgeons to use an older service code when performing free flaps that reimburses at a much lower rate and doesn’t cover the true costs of what it takes to perform DIEP flaps. This has and will continue to wreak havoc on how good-willed surgeons run their practices. The DIEP flap surgery is very technical, tedious, and a true work of art. Surgeons who decide to undergo microsurgery training with the end goal of helping women feel restored through modern surgical techniques are so needed. While this coding change won’t affect more affluent women who can pay privately for their surgery, it will affect the vast majority of women that rely on insurance coverage to afford their breast reconstruction of choice.
Chatting money and cancer care is not easy.
As healthcare providers, it is easy to get caught up in the “business” of things, but we really need to remember why we got into healthcare in the first place. For us at Perky, our purpose is to restore confidence, beauty, and quality of life in those affected by breast cancer. We respect the constant need to evaluate how you can adequately care for your patients while also keeping your doors open. If you are in healthcare and reading this blog: what have been your motivating factor(s) lately?
Skilled microsurgeons definitely deserve to be fairly reimbursed. It is hard to stomach that healthcare is a business and the care you receive truly depends on what your insurance company deems worthy to cover, not what your surgeon is skilled enough to perform. Without insurance coverage, some practices are quoting survivors upwards of $50,000 dollars for breast reconstruction, then making them sign agreements that they will not try to seek insurance reimbursement…how did we get into this mess?! When did trying to feel somewhat complete after breast cancer become so expensive and unattainable?
How crazy is it that insurance companies are ultimately dictating what reconstruction you will receive? We dream for the day all this gets figured out, where survivors can have access and can afford ideal care, physicians are fairly compensated and insurance companies actually care. Kudos to all the advocates trying to make this a reality!
Our perspective as former breast reconstruction nurses and co-survivors.
Courtney and I are both former breast reconstruction nurses. We worked at one of the top breast reconstruction clinics in the nation. We helped many, many women navigate their breast reconstruction journeys and learned so much. While there, I was able to care for multiple family members as they underwent DIEP flap reconstruction. It is such an honor to care for a loved one during a difficult time like a cancer diagnosis. They all went on to do well with their surgeries and are now able to have an excellent quality of life post breast cancer. I am forever thankful to the skilled microsurgeons that helped my family feel whole post mastectomy. I would hope that if I ever needed breast reconstruction, I would have access to DIEP flap reconstruction under insurance, because I don’t have $50k to spare.
Women’s health matters.
When women are healthy and cared for, society thrives. Limiting women’s access to breast reconstruction is not the right move. Currently, our nation is in a financial deficit. Medicare is trying to cut costs, but why take from such a vulnerable population? More women are being diagnosed with breast cancer needing insurance to cover their treatments, including breast reconstruction. So who is to blame? There are so many ways to try and digest the fact that access to natural breast reconstruction is being denied. At the end of the day, who is left to suffer? The woman trying to feel whole again. If you would like to help fight for women’s access to natural breast reconstruction, please consider becoming a CBRA patient advocate. This may not affect you today, but breast cancer isn’t going anywhere. If you have had a DIEP flap, please share your story!
Survive. Revive. Thrive
The Perky Team
