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Published on March 05, 2016

Breast reconstruction decision made easierBreast reconstruction decision made easier

When I was diagnosed with breast cancer 15 years ago, I faced the possibility of a having my breast removed (mastectomy). It was a very scary time.

I was a single parent with many financial challenges. If I couldn’t work because of surgery and if there were additional costs related to my illness and possible breast reconstruction, how was I going to pay for all of this?

Fortunately, I was able to have two lumpectomies and radiation instead of a mastectomy, all covered by my health insurance.

But for women who need a mastectomy and want breast reconstruction, the decision can be difficult when considering copays, deductibles and other associated costs.

Thanks to a $50,000 grant from the Cape Cod Foundation’s Breast Cancer Reconstruction Surgery Fund to support cancer services at Cape Cod Healthcare, there is help for local women.

“We are so grateful for this grant,” said Kathryn Dalton, DO, a breast surgeon at Cape Cod Hospital. “Out-of-pocket expenses can add up and hinder a woman’s decision to have breast reconstruction and this fund will help make that decision an easier one.”

In October, 1998, the Women’s Health and Cancer Rights Act (WHCRA) was passed to protect women who choose to have breast reconstruction after a mastectomy. The Federal law requires most group insurance companies that cover mastectomies to also cover breast reconstruction including the following:

  • Reconstruction of the unaffected breast to make both breasts look symmetrical or balanced.
  • Covers a prosthesis to place in the bra for use before or during reconstruction
  • Covers any physical complications related to the mastectomy such as swelling (lymphedema) in the arms and chest on the side of the mastectomy.

Although insurance companies are required to cover the overall costs, you may have to pay the balance of what your health insurance doesn’t cover. Co-pays can add up as well.

The Cape Cod Foundation grant will cover the expenses associated with reconstructive surgery including copays, deductibles, and surgical costs not covered by health insurance. The only requirement is that the patient has to have had a cancer diagnosis and be a resident in Barnstable County.

For more information about the fund, please visit www.capecodhealth.org/breastfund, or email survivors@capecodhealth.org.

Dr. Dalton estimates that one of five women she sees chooses to go forward with breast reconstruction. Four out of five have breast conservation surgery, which involves removing the tumor or the tumor and a margin of healthy tissue around it.

She offers every woman who needs a mastectomy, the opportunity to meet with a plastic surgeon to talk about her options for reconstructive surgery. “There is always something we can do to help cosmetically, from little surgeries to big surgeries,” said Dr. Dalton.