Dr. Elisabeth Potter and her nonprofit Community Breast Reconstruction Alliance (CBRA) lead a concerted movement by patient advocates, Congressional and Senate leaders, breast cancer nonprofits, and physicians asking CMS to restore a set of specialty insurance codes (s-codes) that provide access to DIEP flap breast reconstruction through insurance. CMS heard the message loud and clear, and in a historic move decided to reinstate these insurance codes, acknowledging that their absence would negatively impact the patient population’s access to needed reconstruction options. This is a huge win for patients across the country, and the first step of many to improve access to all forms reconstruction options.
CBS Morning News covered the story.
Recent changes to insurance have affected patients’ access to modern reconstruction techniques. The good news is that the Women’s Health and Cancer Rights Act of 1998 protects breast reconstruction, so we can fix this problem. We just need to stay engaged and advocate for patients facing surgery to treat or prevent breast cancer.
Read the ARTICLE here to learn more.
Patients should not have to bear a financial burden to access breast reconstruction. Dr. Potter is working to protect access to modern breast reconstruction through insurance for all people facing surgery to treat or prevent breast cancer.
Breast reconstruction using a woman’s own tissue should be an option for all woman facing breast reconstruction; however, access to the best and most modern natural reconstruction procedure, DIEP flap reconstruction, is being threatened due to insurance companies refusing to pay for the procedure women need and deserve.
CLICK HERE for more background information on how access to breast reconstruction is being challenged.
-Help raise awareness about changes to access and insurance coverage of breast reconstruction.
-Share your contact information and your personal experience with breast reconstruction.
-Stay informed about our latest efforts and where your help is needed most.
– We’ve partnered with the non-profit CBRA: Community Breast Reconstruction Alliance to continue the efforts to protect access to modern breast reconstruction. Learn more about CBRA.
-We love our patients and the work we do.
-We have seen reconstruction transform the lives of our patients.
-We believe that all patients should have access to modern breast reconstruction.
-We believe that all patients should be informed about their reconstructive options before undergoing surgery to treat breast cancer.
-We believe that insurance coverage for modern breast reconstruction is necessary and should be protected.
1. Find your senator here to email the below letter to fight for access to autologous reconstruction
2. Paste this text into your subject line:
3. Copy this U.S. Senate letter text into the body of your email and sign your name at the bottom:
1. Find your local representative here to email the below letter to fight for access to autologous reconstruction
2. Paste this text into your subject line:
3. Copy this House of Representatives letter text into the body of your email and sign your name at the bottom:
Breast reconstruction may be performed with an implant or with a woman’s own tissue. The decision is highly personal and individualized. Each patient should discuss the full range of options with their care team and have the chance to choose what is best for them. For example, patients may choose aesthetic flat closure, implant placement, or reconstruction with tissue from another part of their own body.
Natural tissue reconstruction using tissue from a patient’s own body is less commonly performed than implant reconstruction in the United States, but it is increasing as women are informed about their options. Some women choose to use their own tissue because they want a life-long reconstruction instead of an implant, which is not a lifetime device. Some women choose to use their own tissue because they prefer a natural reconstruction over a foreign body or medical device. Some women choose to use their own tissue because they have undergone radiation and understand the increased health risks of having implants in the setting of radiation, such as capsular contracture, infection, asymmetry, and reconstruction failure.
All surgeries are not equal. When natural tissue reconstructions were first developed, surgical techniques were not refined, and the side effects of the surgery were severe. Importantly, early efforts to reconstruct a breast caused harm and injury to a woman’s muscles. In some cases, as in fTRAM reconstruction, an entire abdominal muscle was removed, leaving the woman with lifelong weakness and hernia. As surgeons gained knowledge and experience, they developed techniques that don’t remove muscle. The new surgery, called a DIEP reconstruction, is more difficult to perform, but the benefits to the patient are profound. A woman can have a breast reconstruction with a DIEP flap and still lead an active and productive life, without the lifelong weakness and side effects caused by removing her rectus abdominis muscle.
CMS has announced that they are equating all breast flaps (like DIEP and fTRAM) and insurance companies have begun to stop paying for the more advanced DIEP procedure that women need and deserve.
We are advocating for you! If you want to get involved in these efforts, please email us at email@example.com