Societal Impact - Part IV

A little over two decades ago, October was named National Breast Cancer Awareness Month, to help bring recognition to a disease that hundreds of thousands of American women were battling every day. The 90s and 2000s subsequently saw a flourish of activity related to giving breast cancer patients and survivors a very public face with the infamous pink ribbon, walks and runs, and promoting free or low-cost screenings and public education on early detection. Breast cancer has been further brought into mainstream societal recognition through popular television shows that may dedicate an episode or an entire storyline to women's battles with breast cancer such as the daytime soap operas, The L Word, Sex In The City, and even South Park (albeit an unconventional approach). Some tattoo parlors even get in on the action by allowing people to permanently remember and honor the way breast cancer has impacted their lives or the lives of their loved ones.

However, despite the outpouring of support and recognition for patients and survivors of the disease, there is limited discussion in popular culture around the availability of breast reconstruction options. While it is possible to find multiple and varied examples of breast cancer within popular media, it was far more difficult to find any representations of breast reconstruction amongst TV or film clips. Despite breast reconstruction's modern history over the last forty years, it was not until 1998 that breast reconstruction became a federal policy issue. The Women's Health and Cancer Rights Act of 1998 (Title V; Subtitle C) was signed into law by President Bill Clinton that mandated insurance providers cover minimum "(1) breast cancer mastectomies, lumpectomies, and lymph node dissections; (2) post-mastectomy breast reconstruction on both breasts; and (3) the costs of prostheses and complications of mastectomy, including lymphedemas." Before that point, reconstructive operations were seen largely as elective "cosmetic" surgery that third-party payers did not feel compelled to cover.




The Act provided a national message that women's health care was important, that women should have all treatment options available to them, and that breast reconstruction became "widely recognized as an important element in breast cancer treatment rehabilitation." Despite the passage of the bill, according a study and analysis of reconstructive trends across the U.S. completed in 2004, utilization of reconstruction procedures continues to rise at a rate of only 1% a year, which is comparable to the period before 1998. The study highlights four likely barriers to post mastectomy reconstruction: financial barriers, race-based inequalities in health care, regional differences in access to procedures, and limited patient knowledge. (As an aside, according to the 2004 data, Atlanta has the highest rates of reconstruction following mastectomy treatments and Hawaii has the lowest). In effort to combat the last aforementioned barrier, the American Society of Plastic Surgeons (ASPS) created the first annual Breast Reconstruction Awareness Day or BRA-Day, on October 17, 2012 to provide better education to women about their reconstruction resources and options, even pulling in celebrity singer Jewel as their spokesperson.

In attempts to lift the shroud of mystery surrounding outcomes following surgery, where historically women have only been able to look at photos from other post-op patients,  new survivor support groups have formed such as show-and-tell reconstruction circles as described in a 2012 Canadian interview with BRA Ambassador Theresa Quick and additionally backed by ASPS survey . These circles provide contemplative women the opportunity to see actual reconstructions, touch them, and ask women about their experiences with the surgery, outcome, aesthetics and functionality. It still waits to be determined how the advent of these new educational initiatives will impact future rates of breast reconstruction. However, as women are provided greater comprehensive education on their choices, they will be provided the knowledge necessary to make fully informed decisions.

However, it is important to note that some women actively choose to keep the scars on their chest from their mastectomy and do not attempt to recreate what they sacrificed. An article from the Atlantic in 2011 explained how reconstruction is not always the best choice for women, especially athletes who may not want to compromise anymore of their muscular structure or women who have simply come to embrace their new bodies. Some women even appreciate having a literal weight lifted from their chest and are not compelled to incorporate something "artificial" into their appearance. Breastfree.org is an entire support website and forum dedicated to women who have decided against reconstruction for "positive reasons", including pictures of women with and without breast-forms, because they might consider themselves to be "mature women who understand that love of spouses, friends, and family isn't dependent on having breasts." The choices women make not  to reconstruct are every bit as valid as those who do.