63% of American women have had breast reconstruction after a mastectomy. In France, many women with breast cancer opt for reconstruction.
Breast reconstruction with implants is progressing in the United States. A study, published in the Journal of Clinical Oncology on February 18, an increasing number of reconstructive operations have been observed after a mastectomy since 1998. But one in three patients still cannot have recourse to such a procedure after a preventive operation or after breast cancer. This remains much more than in France where, according to the Observatory of breast reconstruction (1), 26% of women who had a mastectomy in 2005 opted for reconstruction.
Often after a double mastectomy
Breast reconstruction operations after mastectomy, unilateral or bilateral, concerned 63% of patients in 2007. Real progress when we know that in 1998, less than half of them benefited from such treatment. But these figures, taken from the follow-up of more than 20,500 women, hide a more contrasting reality: all patients who have a breast removed – in prevention or after breast cancer – do not react in the same way. Women who have both breasts removed are the most likely to opt for reconstructive surgery. Those who undergo lymph node removal, chemotherapy or radiation therapy, on the other hand, have less use of this solution. This is also the case for older women.
Reduction of flap reconstructions
How to explain this increase in implants? The main reason is the decline in flap reconstructions – which consists of removing tissue and fat from the patient’s body to reconstruct the breast. They have gone from 56% to 25% in 10 years. Women who have had a double mastectomy, either preventive or curative, are almost ten times more numerous than in 1998, and the majority of them (76%) requested an implant reconstruction.
Among the women monitored, 6 out of 10 had health coverage through their employment. But only 56% of them requested breast reconstruction. “Most insured and active patients who have mastectomies, and the vast majority of patients who have double mastectomies, now have reconstruction,” says Dr. Reshma Jagsi of the University of Michigan. But too many women still do not have access to reconstructive surgery, often for financial reasons. This is also the case in France: Health Insurance certainly covers 100% of the costs of breast reconstruction … but the basic price is often exceeded, the remainder to be borne by the patient slows down many patients. But, from March 10, breast reconstruction will be better supported by social security: DIEP reconstruction, which consists of using a flap of skin, fat and the patient’s own blood vessels, as well as the symmetrization of the two breasts will be reimbursed.
(1) Breast reconstruction observatory: evaluation of breast reconstruction in France by the French Society of Senology and Breast Pathology (SFSPM) and the National Cancer Institute (INCa).
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