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Why do we need to amend the WHCRA legislation?

To ensure insurance coverage for flat closure and revision services… so that women going flat don’t have to worry about fighting their insurance companies.

Going flat at initial mastectomy instantly saves your health insurance company thousands if not tens of thousands of dollars. And most often, going flat means you’re “one and done.” However, sometimes a patient will require additional “revision” surgery to produce an aesthetic result that they can live with.

Revision can involve removing excess tissue and/or other contouring procedures to produce a smooth result. This can be required after initial mastectomy, or after removal of implant reconstruction (explant) to go flat.

Insurance companies often refuse to cover revision surgeries, stating that they are “cosmetic” rather than reconstructive, and therefore are not covered by the Women’s Health and Cancer Rights Act (WHCRA, 1998).

Women end up having to spend their limited time and energy fighting their insurance company while recovering from major surgery, just to get the care that they need to move on with their lives.

Too often, if the option to go flat is mentioned at all, it’s cast as a choice that’s “less than.” And in terms of getting a result they can live with, many women don’t have the ability to fight their insurance company during their surgical recovery – so they are forced to live with a “mangled” chest. Whereas their sisters who choose breast reconstruction have their two, three, even up to nine or more surgeries covered by insurance without any suggestion that their surgeries are “cosmetic”.

The original intent of the WHCRA was to ensure that women facing breast cancer surgery were able to achieve aesthetic results they could live with. Who could have forseen that helping women who choose breast reconstruction would end up harming the rest who choose to go flat? Without corrective action, this disparity will endure.

Flat closure does not rebuild the shape of the breast, but it DOES correct a deformity caused by the mastectomy – it restores the normal anatomic contour of the chest wall (hence, “chest wall reconstruction”) – and therefore it is truly reconstructive (NOT cosmetic) and should be covered by the WHCRA, in order to fulfill that legislation’s original intent.

It’s clear, from a reading of the WHCRA text, why flat closure is often interpreted as being excluded from coverage. However, this is an easy thing to fix – we simply need to change “breast” reconstruction in the legislation to “breast or chest wall” reconstruction. It’s that simple!

“… who elects either breast or chest wall reconstruction in connection with such mastectomy, coverage for—
all stages of reconstruction of the breast or chest wall on which the mastectomy has been performed;
surgery and reconstruction of the other breast or chest wall to produce a symmetrical appearance…”

Women’s Health and Cancer Rights Act of 1998

One in eight women will face a breast cancer diagnosis in their lifetime. And four out of five women over the age of 60 who have mastectomies, decide to go flat. That’s a lot of women potentially facing suboptimal care and additional hardship at one of the most vulnerable times in their lives.

According to Not Putting on a Shirt’s research, which was presented at the San Antonio Breast Cancer Symposium this December, one in four women going flat receives an unsatisfactory aesthetic result, and 1 in 20 are intentionally denied by a surgeon who believes they will “change their mind” about implant reconstruction and so disregards their consent. There is a lot of room for improvement here.

Amending the WHCRA to include insurance coverage for flat closure (chest wall reconstruction) will be a critical step in ensuring these women receive the care they deserve.

Questions? Comments? Want to do more to help?