Although too many women who have mastectomy still don’t know about their reconstruction options, awareness of surgical procedures continues to expand. More women in all walks of life—celebrities, housewives, business executives and physicians—bravely share their mastectomy and reconstructive experiences in articles, interviews, blogs, memoirs and seminars, and information about reconstruction is all over the internet. This new openness serves to help women become more aware of mastectomy experiences and the many reconstructive choices that are available. Breast Cancer Awareness month, Breast Reconstruction Awareness Day and other similar awareness campaigns also help. At the same time, an increase in the number of surgeons who perform breast reconstruction, and a wider variety of procedures make reconstruction more available.
But at least one significant barrier remains: local availability of plastic surgeon who perform breast reconstruction. In many parts of the country, it is simply not available; in other areas, a woman’s options may be limited to only the most traditional reconstructive methods.
Using data from the National Cancer Database, researchers at Memorial Sloan Kettering Cancer Center analyzed the relationship between travel distance and breast reconstruction in more than 1 million women who had mastectomy in the U.S. from 1998 to 2011. During that time, immediate breast reconstruction more than tripled, from 10.6 percent in 1998 to 32.2 percent in 2011.
Women who had mastectomy with immediate reconstruction traveled quite a bit farther than patients who had mastectomy without reconstruction. About 14% of women who traveled up to 20 miles for their breast cancer treatment had immediate reconstruction; almost 25% of women traveled between 100 and 200 miles. During the study period, the distance traveled by women who had reconstruction increased by 2% per year (no significant change in travel distance was found for women who didn’t have reconstruction).
If you’re shopping around for breast reconstruction, you may be fortunate enough to find the surgeon and procedure you want right in your hometown (or at least nearby). More likely, especially if you don’t live in or near a teaching hospital or a large city, your options will depend on how far you’re willing to travel for the procedure or the surgeon you want. You’ll find lots of DIEP surgeons, for example, in hospitals and in private practice in Chicago, New York City, Dallas, and other cosmopolitan areas of the country. But in other areas of those same states, not a single surgeon does DIEP, TUG or GAP. Reconstruction with breast implants is far more common, because pretty much all surgeons who do any breast reconstruction procedure also offer implant reconstruction. But even that isn’t available in all towns and cities in the land: your local surgeons may be adept at traditional implant reconstruction with tissue expanders, but don't have experience with direct-to-implant surgery or other newer procedures.
So, depending on where you live, you might find yourself with a wide variety of reconstructive surgeons and choices, limited alternatives, or none at all. You’ll have to decide then whether you’re willing to take what’s available locally (or whatever is closest), or travel to get what you want.
Other factors also influence traveling for breast reconstruction. Time, cost (insurance doesn’t typically cover travel for this type of surgery), and perhaps arranging for child care while you’re away. On the other hand, a reconstructive choice may be available in a distant city where you happen to have relatives or close friends, so that might also work out. Insurance can also be a HUGE factor: if you have an HMO, as most Americans do, your coverage will likely include only in-network surgeons for your mastectomy and breast reconstruction. If you have a PPO, you’ll have more latitude concerning where you can go and who you can see for your procedure.
Source: Albornoz CR, Cohen WA; Shantanu R, et al. “The Impact of Travel Distance on Breast Reconstruction in the United States.” Plastic & Reconstructive Surgery (2016) 137:1; p. 12-18.