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Breast Reconstruction should be discussed when Breast Cancer Diagnosed

Recently New York State has mandated a discussion of options for patients with Breast Cancer. Since my training at Sloan Kettering in New York I could not conceive of a woman not being offered the options of breast reconstruction when told of their diagnosis. A New York Times excerpt follows.

Before Breast Is Removed, a Discussion on Options
By ANEMONA HARTOCOLLIS
Published: August 18, 2010

After her mastectomy in April, Alantheia Pena cried for the loss of her breast. Her partner told her not to worry about the flat spot on her chest, but she could tell it bothered him when he looked away as she took off her shirt.

It was a kindly secretary at the place where she went to get her prosthesis, an artificial breast to fill out her clothing, who noticed her crying and told her that she could have her breast reconstructed, with health insurance covering the cost. Ms. Pena said her cancer surgeon had not told her.

Now a state law signed on Sunday by Gov. David A. Paterson will require New York hospitals and doctors to discuss the options for breast reconstruction with their patients before performing cancer surgery, to give them information about insurance coverage and to refer them to another hospital, if necessary, for the reconstructive surgery.

The law came about largely through the efforts a plastic surgeon at Montefiore Medical Center in the Bronx who gave Ms. Pena, who will turn 48 next week, a new breast, which made her so happy she wore a bikini last month for the first time in her life.

"It gave me back my life, Ms. Pena, who runs the H.I.V. ministry at Friendship Baptist Church in Brooklyn and lives in the Bronx, said on Wednesday. "It’s like my own breast. It’s beautiful. It’s perfect. It’s a perfect breast.

Dr. Garfein, who specializes in reconstructive surgery after breast, head and neck cancer, said he had pushed for the law after a friend of his, Dr. Caprice Christian Greenberg, co-wrote a paper showing that poor, minority women were much less likely to receive breast reconstruction after cancer than more affluent women.

Congress guaranteed universal coverage for breast reconstruction after cancer surgery in 1998. Only 30 percent to 40 percent of the women who had mastectomies now received breast reconstruction.

The number would be closer to 75 percent if more women were informed of their options. Ms. Pena, had her surgery at North General Hospital in Harlem, which is defunct, but she said her doctor there had never discussed breast reconstruction with her.

One reason for the low rate of reconstruction, Dr. Garfein said, may be the lack of plastic surgeons outside of large academic medical centers, and another may be financial.

Ms. Pena is still recovering from cancer, but with her new breast, she said, "at the end of it, you see some kind of rainbow.

Available every week to fit in breast reconstruction consults to discuss options. Larry Weinstein MD FACS www.drlarryweinstein.com

Posted in breast reconstruction, Breast Surgery on September 23rd, 2010

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