Midwest Breast and Aesthetic Surgery is committed to offering its patients a full range of advanced reconstructive and cosmetic procedures for restoring the structure and enhancing the appearance of the breast and body.
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Good morning Chairwoman Jones, Vice Chair Burke, Ranking Member Cafaro and members of the Senate Medicaid, Health and Human Services Committee. Thank you for the opportunity to present Testimony on the “Lizzie B. Byrd Act.”
In May of 2011, House Bill 217 was introduced in the 129th General Assembly. This bill highlighted the fact that not all Ohio women were aware that they could obtain breast cancer reconstructive surgery at the same time they obtained a mastectomy, while having both procedures covered by insurance.
As a Reconstructive Plastic Surgeon, much of my clinical practice is focused on reconstruction after cancer. Many of my patients undergo reconstruction at the time of mastectomy for breast cancer. I would like to highlight two specific aspects of breast reconstruction based on my clinical experience. I will divide these considerations into “patient-centered” and “care management.”
“Patient-centered” – Breast reconstruction at the time of mastectomy (immediate reconstruction) allows patients to move beyond the stigmata of disease that often persist after completing mastectomy, chemotherapy and radiation treatment. It is well accepted in the medical literature that the physical deformities of treatment lead to impairment in patient quality of life. Breast reconstruction at the time of mastectomy has significantly demonstrated quality of life improvement for patients. This data results from studies using validated survey questionnaires submitted to patients who have undergone reconstruction and those who have not undergone reconstruction. Quality of life improvements include return to work and to activities of daily living as well as improvements in psychosocial outcomes such as the incidence of depression among breast cancer survivors.
“Care management” – Immediate reconstruction reduces the overall cost of care as compared to reconstruction performed at a later time point (delayed reconstruction). As part of the Women’s Health Care Act of 1998, reconstructive breast surgery after mastectomy falls under the purview of insurance coverage. Immediate reconstruction reduces the overall numbers of days spent in the hospital and the number of revisionary lifetime surgeries as compared to delayed reconstruction. Clinical evidence demonstrates that certain types of immediate reconstruction may reduce the incidence of chronic lymphedema and the attendant costs associated with lifelong management of this chronic condition. Finally, the “Lizzie B. Bird Act” presents a model for vertically integrated physician collaboration that should increasingly become the standard for Accountable Care Organizations (ACOs). Improved care coordination among the members of the healthcare team (medical oncology, surgical oncology, radiation therapy and reconstructive plastic surgery) limits the potential for errors in clinical judgment that lead to costly revisionary surgery.
In my clinical experience, information to the patient regarding her options for breast reconstruction at the time of mastectomy leads to improved care coordination and improved patient outcomes with a decreased incidence of lifetime surgery. I would be happy to provide references from the scientific literature should the committee request them.
Again, thank-you Chairwoman Jones and members of the Senate Medicaid, Health and Human Services Committee. I will be more than happy to answer any questions that you may have at this time.
