D. Bhat1, K. Amanjee1, M. Dunne1, A. A. Talwar1, J. Ricci1 1Albany Medical College,Division Of Plastic Surgery,Albany, NY, USA
Introduction: The breast cancer survivor today has choices in breast reconstruction; she can opt for implant-based reconstruction or elect to use autologous tissue transfer (free or pedicled). The Women's Health and Cancer Rights Act of 1998 mandates that all patients undergoing mastectomy for breast cancer have full health insurance coverage for their preferred choice of reconstruction. This choice is actually not so clear-cut: patients living in more rural areas may not have access to a microsurgeon for free tissue transfer or even a plastic surgeon that performs implant-based reconstruction. The aim of this study is to identify patient access to breast reconstruction in upstate New York, specifically focusing on access to free tissue transfer-based reconstruction.
Methods: The New York State Department of Health website (https://profiles.health.ny.gov/hospital/) was queried to identify all hospitals in the state of New York. Hospitals were divided into the following regions: Capital District, Central New York, Hudson Valley, Buffalo, and Rochester. Hospitals in Metropolitan New York were not included as a part of this study. Each hospital was contacted to investigate whether the hospital had the ability to treat breast cancer, whether a plastic surgeon was available for patients seeking breast reconstruction, and what types of reconstruction were offered (implant-based, pedicled flap, free flap).
Results: A total of 135 hospitals were surveyed. Fifty-five percent of hospitals report having the ability to treat breast cancer. Fifty-two percent of hospitals have hematology-oncology services available, and forty-four percent have radiation-oncology services available. Twenty-one percent of hospitals report having a breast surgical oncologist available. Forty-one percent have a plastic surgeon available at their institution and thirty-two percent of hospitals queried have plastic surgeons that perform breast reconstruction. All of the hospitals (100%) that perform breast reconstruction perform implant-based reconstruction. Twenty-one percent of queried hospitals in upstate New York perform pedicled flaps for breast reconstruction, with only fourteen percent of hospitals performing free-flap based reconstruction.
Conclusion: There is an overwhelming discrepancy between hospitals having the ability to treat breast cancer and availability of plastic surgeons for reconstruction. While over half report the ability to treat breast cancer, less than one-third of surveyed hospitals in upstate New York perform any type of breast reconstruction. Although federal law mandates that breast reconstruction be completely covered by health insurance, patients may not be undergoing breast reconstruction due to limited access to plastic surgeons in their area.