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.
Every year, Plastic Surgeons from all over the world come together for the Annual Meeting of the American Society of Plastic Surgeons. This conference, known as Plastic Surgery The Meeting 2015, or for you Twitter folks out there, #PSTM15, offers hundreds of lectures and courses that cover pretty much every topic in Plastic Surgery: from skin care to advanced reconstruction, and from practice management to national and global health care policies. Since our practice focuses on plastic surgery of the breast, I can only really highlight the things that apply to this area:
Dr. Ergun Kocak, MD, MS, is a board-certified plastic surgeon who specializes in plastic and reconstructive surgery of the breast using DIEP, SIEA GAP, TUG, PAP, and direct-to-implant, in Columbus and Cincinnati, OH.