Breast Reconstruction: 2012 Statistics and the Sounds of Silence!

You are not likely to hear the tears of a woman sent home from her doctor after he or she tells her that breast cancer reconstruction has failed and there is nothing more that can be done for her.

You are not likely to hear her tears as she looks in the mirror at herself with disgust.

You are not likely to feel the pain in her abdomen as her husband walks out the door because he can no longer bear to look at or touch the scars of a chest that caves inward.

You are also not likely to hear her complain... to anyone.

She sits alone; quiet, unbelievably sad, often wondering why she was the one to survive. She looks at the breasts of other women with envy. She becomes isolated feeling undesirable and ugly. She feels guilty about the feelings she has with no one to guide her in any direction.

In her mind, no one cares because no one really understands.

Not all of the stories I hear are exactly like this, but many of the ones I hear on a daily basis are, and they continue to sadden me. Just the other day, a friend of mine told me she saw a woman who was horribly disfigured. She looked at my friend and said what I have often thought myself, "Who would want this?"

According to the American Society of Plastic Surgeons statistics, there were 14,629,276 total cosmetic surgeries in 2012; 5,612,649 of those were reconstructive procedures. There were 91,655 breast cancer reconstructive surgeries and 68,416 breast reductions that were considered reconstructive procedures. If you do the math, it shows that less than 3 percent of reconstructive plastic surgery procedures were performed for breast cancer reconstruction.

What does that mean? Can nothing be done? Are women being sent home disfigured unnecessarily? Are we as women and physicians uninformed of available procedures? Do the majority of plastic surgeons choose not to make breast reconstruction a part of their practice?

Another sound of silence is money! It is a very taboo issue; one that even I cringed while discussing this very issue with my own doctor.

Here are some of the problems perhaps from a plastic surgeon's perspective when choosing whether or not to perform breast reconstructions:

1. Breast reconstruction is not an elective surgery. Therefore, the money for the surgery is not paid in-full prior to the procedure.

2. Hospitals and insurance companies only pay a negotiated price per procedure, reducing the net income of a practice.

3. The initial payment from a patient may not be collected for various reasons resulting in the need for collections adding costs to the practice.

4. Liability... need I say more.

If I were a plastic surgeon, I would probably lean towards making breast reconstruction a very small part (if any) of my practice for obvious reasons. They call it incentive, or the lack of it. Is it morally right? Perhaps not, but again, the capitalist in me is going for the money.

Don't get wrong. I am a plastic surgeon cheerleader and there are very many dedicated plastic surgeons working on breast cancer reconstruction procedures every day. Dr. Sergio Zamora, Daytona Beach, FL (my doctor), is truly one of them. He and I both want the numbers to change.

I do not have the answers to remedy the problem that exists; I just know we have one. Any suggestions would be appreciated. Along with the suggestions, any suggestions for implementing these suggestions would also be appreciated.

Please remember, when I post something in regards to breast cancer reconstruction, I am doing so with the intent to help only those women who have chosen to have reconstruction and have had problems. In no way would I ever wish to offend one who has not and does not wish to have reconstruction.

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