American Society of Plastic Surgeons
For Consumers

Access to Microsurgical Breast Reconstruction

Ensuring Access in the Face of Private Payer Reductions

ASPS is working to increase access to microsurgical breast reconstruction by educating commercial payers about its value to the health system and the support for it in the patient community.

While undergoing a mastectomy is a traumatic experience, many women return to wholeness and find a better quality of post-reconstruction life because exceptional surgical options exist to restore the natural appearance and, increasingly, feel of their breasts. Microsurgical breast reconstruction – which uses a woman's own tissue for post-cancer breast reconstruction – provides both the highest such quality of life and patient satisfaction results and excellent clinical outcomes.

It also offers an essential treatment option for many women. In addition to a woman's purely personal choice to not have implant-based reconstruction, some women are not medical candidates for an implant-based procedure because they have had or will need radiation therapy, which affects a woman's body in ways that increases risks for medical complications if an implant is used.

Unfortunately, women have steadily been losing access to microsurgical breast reconstruction since November of 2021, when some private health insurance companies began making policy changes that do not accurately account for the technical complexity and length of this surgery.

Because of these payer payment policy changes, breast cancer patients with private health insurance are losing access to an entire class of provider type – community-based, private practice breast microsurgeons – who are already in short supply throughout the country. Combined with those existing access challenges, the changes payers are making will mean that some women will lose covered access to this breast reconstruction option outside of major hospital systems, where payers are not currently changing their policies or the changes are not impacting access. Major hospital systems are wonderful, but they do not have unlimited capacity, and they are not easily accessible to every woman with breast cancer.

Ultimately, ASPS is concerned that private practices currently dedicated to providing these post-cancer breast reconstructions to insured patients will transition to other practice models, and if that happens, patients will have fewer options if they need a surgeon skilled enough to do a microvascular-based breast reconstruction procedure.

In an effort to halt the spread of changes that threaten access to microsurgical breast reconstruction and expand the health system's capacity to offer it, ASPS launched a far-reaching initiative to work directly with the private insurance industry in a focused manner to educate them on the need to ensure access to these procedures and work with public policymakers to modernize patients' insurance coverage rights so that these procedures are widely offered by community and health system microsurgeons.

This is the home page of a series of web pages dedicated to galvanizing plastic surgeons, cancer and breast reconstruction patients and all of the organizations dedicated to supporting cancer patients to ensure access to microsurgical breast reconstruction. These pages provide an opportunity for members of the public and interested organizations to connect with ASPS about supporting this effort, and they provide ASPS members with member-only information on the history of this issue, the strategic contours of ASPS's response to eroding access and their opportunities to join or follow the ongoing projects under the ASPS Initiative.