Surviving Breast Cancer: Reconstruction Surgery After Mastectomy More Popular Than Ever

The number of women opting for reconstructive surgery after mastectomy has surged in recent years, due to a number of factors including health insurance coverage, improvements in treatment and increased awareness about the disease. Jim Bourg/REUTERS

The number of women who opt for breast reconstruction after mastectomy has skyrocketed 65 percent in five years.

According to a report published Tuesday by the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services, the rate of women 18 and older opting for breast reconstruction from 2009 to 2014 increased from 21.7 per 100,000 to 35.1 per 100,000.

Though the report doesn't explain the reason behind the trend, Anne Elixhauser, senior scientist at AHRQ and coauthor of the paper, says a number of factors may be influencing why more women are undergoing the surgery after breast cancer treatment. They include policy changes for health insurance companies that now mandate coverage, improvements in the procedure itself and increased awareness about the disease. Others argue the trend is partially driven by public figures such as Angelina Jolie, who in 2013 spoke out candidly about her decision to undergo prophylactic mastectomy and reconstructive surgery after learning she is a carrier for the BRCA gene mutations that significantly increase her risk for the disease.

The new report finds the popularity of the surgery increased in women of all age groups, but primarily in those older than 65. From 2009 to 2014, the number of seniors opting for reconstructive surgery surged by 140 percent. That finding may also reflect the reality that breast cancer primarily strikes women in later years of life.

The researchers also found that breast reconstructive surgery was more popular in women living in urban areas compared with women in rural areas. "This may be an issue of the lack of access to facilities that perform reconstructive surgeries for women in rural locations," Elixhauser told Newsweek.

It is now also far easier to undergo breast reconstruction, which is increasingly available on an outpatient basis. By shortening the recovery time from the surgery, women are much more likely to choose it. The report found there was a 150-percent increase in reconstruction surgeries performed in hospital-based ambulatory surgery centers on an outpatient basis. Breast reconstructions in ambulatory outpatient facilities increased from 7 per 100,000 women in 2009 to 18 per 100,000 in 2014. However, the rate of women undergoing breast reconstruction on an inpatient basis remained unchanged over the time period: 7 per 100,000.

Policy changes have certainly influenced this trend, says Elixhauser. In 1998, Congress passed the Women's Health and Cancer Rights Act, which requires all group health insurance plans cover reconstructive surgery as part of treatment standard for breast cancer. Medicare is also required to pay for breast reconstruction, and Medicaid coverage varies state by state, with many providing the service to breast cancer patients at no cost.

For some time, breast reconstruction after mastectomy was classified as a non-essential frivolous luxury for patients. And while one can argue that is technically the case from a purely medical perspective, there's now plenty of research that highlights how critical it is to recovery for some women.

"After a mastectomy, a woman faces a complex and emotional decision about whether to have breast reconstruction or live without a breast or breasts," the researchers write. "There are usually three main considerations in the decision: medical, sexual, and physical. Medical considerations include concerns that breast reconstruction surgery lengthens recovery time and increases the chance for infection and other postoperative complications. Sexual considerations involve the impact of the mastectomy on future sexual encounters. Physical features include how breasts may define femininity and sense of self."