Breast Reconstruction: Waiting Lists One to Two Years

"   Breast cancer   ? It's a luxury that everyone can not afford.   "Stephanie, 37, a house painter in the Dauphine, just kidding. In July 2010, she learned that she had a tumor in her left breast and that she urgently needed ablation. Stephanie, who wants to continue wearing dresses and return to the pool as soon as possible, do not hesitate long: no question of living with one breast less! While she is about to be operated on at the local university hospital, word of mouth warns her surgeon, famous for the nasty scars he leaves to his patients. Stephanie then opts, confidently, for a plastic surgeon practicing in a reputed private clinic. After all, breast reconstruction after cancer is 100% covered by Health Insurance.

Certainly. But his complementary refuses him the overtaking of fees for the installation of his prosthesis, that is 500 € minimum in all. A soft price, when some practitioners multiply the Social Security rate by ten, but a salty bill for this separated mother (" My guy did not support my new" chemo look ""), and who does not receive more than 700 € per month, being on long-term sick leave. " As if I had asked for cancer so I could have my breasts redone ... "

Like Stephanie, each year in France, 20,000 women undergo the removal of one breast, or both (in 30% of cases). " Only about 35% of mastectomized women have their breasts rebuilt," says Professor Laurent Lantieri, head of the plastic surgery department at Henri-Mondor Hospital in Créteil ⁽¹⁾ . A very low figure for a developed country like ours. And not only because the majority of patients prefer to live with one breast less than to go back to pool, or to take care of one breast, like the Amazons ⁽²⁾ . But also because being rebuilt in France is a path of the fighter in which all women, alas, are not equal.   "

It all starts with the choice of the establishment. Many public plastic surgery departments have been closed. " There are only two left in Paris," says Professor Lantieri. To compare with the ten departments of urology. Today, much more is invested in human, financial and technical resources for prostate cancer than for breast reconstruction. In our macho society, caring for 70-year-old men is much more important than rebuilding a 50-year-old woman . In addition, not all hospitals that practice mastectomy offer reconstruction, and patients who seek it are sometimes lectured: " Do you feel happy to be alive? The rest is accessory . Some people even say, " You're 60, you can live with one breast less. "

As for those who practice reconstructions, they post waiting lists of one to two years ... Unless agree to consult his practitioner in his private practice. " At the Georges-Pompidou European Hospital in Paris, I was offered an operation within thirteen months," says Aude, 36, a professional press reporter. I saw the same surgeon in the private sector. Three months later, I was rebuilt. Exceeding fees, 1   000 €, did not cost me anything, my mutual offering excellent coverage . "

Not all women are so lucky. And they rage even more when it is the public hospital that sends them into the private sector, like Danièle, 59, a teacher. After her mastectomy at the Gustave-Roussy Institute in Villejuif, which only performed immediate reconstructions - on patients who did not need radiotherapy after the ablation - she was referred to the private consultation of a doctor. surgeon at Rothschild Hospital, Paris. " He announced to me a fee overflow of 3   000 € for a breast prosthesis. But my complementary, the Mutual General of Education, does not appreciate at all overtaking ... "

For her part, Liliane, a 50-year-old civil servant, was reimbursed only € 150 on a € 1,000 bill: " For a fat autograft to the rib cage, in a private clinic, operation not practiced by my hospital.   "Veronica, 48, an official in the Pas-de-Calais, said she was forced to go private" to save his skin ":" I had a very aggressive cancer, and time for a a simple information meeting at the Oscar-Lambret Center in Lille was desperately long. I did not have a fortnight to lose. So I went to a clinic for ablation and reconstruction. Exceeding my charge   : 2   500 €. I had to borrow.   "

Breast reconstruction: "Finishes" not reimbursed

More surprising: some operations of " finishing " of the new breast, while essential, are not all supported by the Health Insurance. It is the case of the symmetry of the breast, which corrects the differences between the breasts: " You imagine what it is like to see oneself in one's mirror, with a new breast smaller and higher than the other   ? Sophie asks. Stephanie, bitter, saves to pay for its symmetry: " Cancer has mutilated me but, for the mutual, repair is cosmetic surgery . "

Catherine, she has just had a (bad) surprise: " Ten years after the installation of the breast prosthesis of my" healthy breast ", to balance my new chest, I had to redo everything, the old prosthesis having aged. I then learned that the Social Security did not take care of that breast. 1   500 € from my pocket . Nine thousand symmetrization interventions would be performed each year. The High Health Authority (at the request of the National Union of Health Insurance Funds, itself questioned by Roselyne Bachelot, then Minister of Health) is currently studying the assumption of responsibility for these operations that are not part of the classical cosmetic surgery. Case to follow.

Same problem with the reconstruction of the areola and the nipple, whose care varies with the technique - tattoo or transplant. The supplement of Pascale, 42 years old, tax inspector, refused to refund her skin transplant taken in the groin, or 750 € she had to pay from her pocket. That adds to the € 1,200 due to his surgeon (his complementary reimburses him only 180 ...), after a " commercial gesture " of € 300. " For mutuals, it is apparently a luxury to have nipples to dare to show naked again to his man, " stifles Genevieve.

Breast reconstruction: Surgeons more or less conciliatory

For Professor Lantieri, it is obvious that there is a two-tier medicine for breast reconstruction: " It is a public health problem. When we have ablation in the public, we should be able to rebuild the public. It's not cosmetic surgery. This is part of cancer treatment. "

" Certainly, there are practitioners for whom cancer is a business," said Nicole Alby, a psychologist with the National Cancer League . But others, more correct, make pay according to what reimburses the complementary. They ask 5   000 € to those who are well supported, and grant prices, sometimes staggered, to the poorest. And then we do not have to ruin ourselves to be rebuilt by the spawn. His collaborators work just as well . "

Poor support for reconstruction impoverishes a few more women already weakened. " It is in the precarious middle class that reconstruction is a problem and inequalities are breaking out," says Nicole Alby. In the first line, very small wages, part-time work ...   All those who do not earn enough to benefit from a complementary and still too much to qualify for universal health coverage, like five million French. Cancer highlights all the social difficulties that women already knew before their illness, and among them many isolated mothers who must both boil the pot, heal themselves and find a way to care for their children during their hospitalization. " Misinformed, health system ignoramuses are unaware that they can still find some financial support for the National Cancer League   "Says Jackie Platon, head of social service at the Saint-Louis Hospital in Paris. She manages daily desperate situations.

Breast Reconstruction: A Little Known Technique

In addition to social inequalities, there are inequalities of information on reconstruction techniques. How many cancer patients have they heard of free flap breast reconstruction (better known by its acronym: diep, for " deep inferior epigastric perforator ")? This is the ultimate breast reconstruction, practiced by Pr Lantieri and his team and some other services in France. A technique less mutilating than the long dorsal, often proposed in hospitals , since it preserves the muscles. It consists, basically, in using the skin and the belly fat, reinjected into the new breast of very natural appearance, which grows and loses weight with the patient. But this complex technique is still not widespread in France, to the great regret of Professor Lantieri: " In the Netherlands, Belgium and the United Kingdom, it is between two hundred and two hundred and fifty per year and per center. We are painfully beyond the hundred. Result   : fourteen months of waiting at home to be rebuilt . "

Record beaten by Professor Phillip Blondeel ⁽³⁾ (nicknamed " Zeus " by his patients): two years of waiting! This European diep star operates in Switzerland and Belgium. French women willing to wait to be operated by " the master " represent between 10% and 20% of the total of his patients hosted in Montreux. Rate ? Not within reach of all budgets if we believe the word of mouth. And his Belgian team also operates around 5% of French women in Brussels.

Why is the diep so little proposed in the Hexagon? For Lantieri, one of the reasons is how the surgeons are paid by the act. " If a practitioner performs five acts in five times for a reconstruction such as the big dorsal, he is paid five times. While the diep is done in one time only, for more than four hours of work. It does not encourage change of technique . "

He has therefore suggested to our health authorities to take inspiration from the example of the Netherlands: the Dutch surgeon receives a lump sum over two years, during which he can carry out all the operations he wishes. " So clinics and hospitals went to diep. "

For the doctor Françoise Barry of Long-field, surgeon in Paris, who fought so that the inflatable prosthesis with expander (to stretch the skin) is taken in charge by the Health insurance, the inequalities between the patients are the consequence direct social security tariffs. " Unlike the baguette, they have not moved for decades," hole of the Secu "requires. A mammary prosthesis, a delicate operation under general anesthesia, is "royally" paid € 230. The consultation of a specialist surgeon   ? 24 €. To compare with the price of a locksmith called a Sunday   ! At this rate, city surgeons are forced to practice overruns, otherwise they lose money . "

Be that as it may, France has a Cancer Plan, and 2011 has been proclaimed " year of patients and their rights"   ". But cancer patients wait for acts. In France, breast reconstruction after cancer is no longer considered a luxury.

1. Author, June 26 and 27, 2010, of the first total facial transplant. He will practice at the Cochin hospital, in Paris, in 2012. 2. www.lesamazones.fr. 3. Founder of Beautiful ABC ("   The beautiful after the breast cancer foundation   ", Http://web.mac.com/phillip.blondeel/Beautiful_ABC/Goals.html), for research and training in reconstruction techniques, particularly in developing countries.