Breast Reconstruction: Who Decides What Goes in My Body?

Managed health care makes me nervous. It appears that in the interests of saving money, it is sometimes the managed health care system that decides which breast implants are available for our plastic surgeons to use. The pendulum may have swung too far. It is prudent to control costs, but deciding exactly what goes in my body should be up to me, the patient, in collaboration with the expertise of my surgeon.

Many manufacturers make multiple kinds of breast reconstruction implants. I want the breast implants that are the best choice for my body. There are many choices out there because companies have put time, effort, and, yes, research and development money, into providing these choices. We are each unique individuals with unique circumstances and bodies — especially after cancer – and we deserve access to the specific breast implant choices that are best for each of us.

It is time for patients to be more discerning consumers. It is time for patients to do their own research and to speak up before a procedure. When choosing plastic surgeons and surgery locations, ask how many brands and types of implants they use and if there are limits on what the plastic surgeon is allowed access to use during a procedure.

The plastic surgeon comes into the operating room to rebuild breasts after the general surgeon has removed the natural, original breasts to either prevent or remove breast cancer. At one of my follow-up appointments, my plastic surgeon had just gotten off the phone with the managed health care hospital. The large hospital, after years of working with this surgeon, was now trying to dictate which implants could be put in the surgeon's patients! The hospital wanted to make the decision about which implants they would stock based on, you guessed it, cost.

As you may know from my previous article, the managed care hospital was already dictating which local anesthetic could and couldn't be used for breast reconstruction surgery. Only the short-lasting bupivacaine was made available, not liposomal extended-release bupivacaine, which offers up to three days of local numbness instead of only a few hours. Bupivacaine generally wears off about the time the patient is getting into their hospital room. Liposomal extended-release bupivacaine allows time for a patient to recover from the general anesthesia and to get on top of their pain management. It can spare a patient from the worst of the immediate post-surgical pain, and yes, you guessed it, it costs about two hundred dollars more than bupivacaine. So now the managed care system also wants to dictate what implants go in my body?

Patients need to be their own advocate if they want a say in whether they get short or long-lasting pain relief, and if they want a say in what implants are placed in their bodies. It is unfortunate that negotiated agreements in pricing for procedure codes between large insurers and large managed health care systems bring us to this point. It is unfortunate when it appears that managed health care systems may be more interested in money for hospital expansion projects than for managing pain and providing the best care for patients currently under their care.

I encourage fellow patients to do more self-advocating and to become more discerning medical care consumers. I hope and pray that managed healthcare systems start providing more than lip service to phrases like "patient-centered care." If not, there will continue to be cost savings without humanity or choices, and it will be the patients who will continue to suffer for it.