It is a sad and alarming fact that regardless of who you talk to in healthcare, the perception is that breast cancer rates are increasing, especially among younger women. As a result, the need for mastectomy and reconstructive surgeries is also increasing. It then seems sensible to presume that the number of surgeons who perform post-mastectomy reconstruction must also be on the rise, a standard supply increases to meet demand sort of equation. Instead, the number of plastic surgeons willing to perform post-mastectomy breast reconstruction is steadily decreasing, an anything but standard equation that Dr. Alissa Shulman, of Sovereign Plastic Surgery, faces daily.
Unlike cosmetic breast surgery, post-mastectomy reconstruction is a painfully long process, for the patient most definitely, but also for the surgeon, taking 1-2 years to reach completion. Prior to even scheduling the surgery, the plastic surgeon will spend 2 hours just talking to the patient. Because the patient’s health is already compromised by cancer and cancer treatment, the risk for complications and infection is increased. The need for monitoring the patient increases as well, requiring weekly visits for months post-surgery. Meanwhile, it commonly takes up to 1 year to be reimbursed by insurance companies because once “plastic surgery” is part of the billing terminology, insurance companies will pull every trick they have to avoid and delay payment. The result is that a dedicated plastic surgeon will give many, many hours of unreimbursed time to his or her mastectomy/reconstruction patient.
Plastic surgeons, many of whom go into plastic surgery envisioning a career helping women by performing post-mastectomy reconstructive surgeries, quickly find out that taking on too many of those patients threatens the survival of their practice. Dr. Shulman estimates that about 80 percent of plastic surgeons do only self-pay patient cosmetic surgery. Forced to choose between self-paying cosmetic surgery patients and the arduous battle to get insufficient insurance reimbursement for post-mastectomy reconstruction surgeries, many plastic surgeons give up and do only cosmetic surgery. This is especially the case in a community like Sarasota, where there is never a shortage of people willing and able to pay cash for cosmetic surgery.
So are plastic surgeons who perform post-mastectomy reconstructions destined to go extinct? Not necessarily, not if we spread the word.
Dr. Shulman estimates that she needs a roughly 50/50 patient ratio in order for her to take on post-mastectomy reconstruction patients without putting her small private practice in the red. Were there multiple plastic surgeons in our community performing post-mastectomy reconstructions that would be plausible as they would be able to spread the patients out among them. Unfortunately, Sarasota is down to three, and that’s if we’re geographically generous by including Lakewood Ranch. That means that a plastic surgeon like Dr. Shulman is taking more post-mastectomy reconstruction patients than her practice can really afford. By necessity, she needs as many cosmetic patients as she can take on in order to subsidize her ability to perform the post-mastectomy reconstructions.
We may not be in a position to force insurance companies to fix this situation, but we can have an impact. We need to shine a community light on Dr. Alissa Shulman, Dr. Christopher Adamson, and Dr. Joshua Kreithen, and any other plastic surgeon in my community or your’s who despite the odds, continues to serve the needs of breast cancer patients. The next time you or anyone you know is thinking about the next cosmetic nip or tuck, think about going to them. By doing so, you’ll help ensure that the breast cancer patient facing a life-saving mastectomy will not need to relocate just to have the option of reconstruction.