Some Hidden Choices in Breast Reduction by Natasha Singer, which is most insultingly a part of The New York Times' "The Price of Beauty" series, explored the different options women are offered - and not offered - after a mastectomy. I'm sure that readers will be shocked - shocked! - to hear that women are not always informed of the different types of breast reconstructions available because some procedures are less profitable for doctors and hospitals than others. Profit above women's health? Who wouldda thunk it? Sigh.

The other problem is that many doctors are not proficient in alternate types of surgery, thus limiting women's choices. In this instance, the article points out that doctors don't tell women that there are other options, preventing them from seeking surgeons who do know how to perform them. What? Self-interest above that of the patient? Who wouldda... never mind.

Of course, the biggest problem of all is that many women aren't told they have any reconstruction options:

Only one third of women undergoing operations for breast cancer said their general surgeons had discussed reconstruction at all, according to a study by Dr. Alderman of 1,844 women in Los Angeles and Detroit that was published in February in the journal Cancer.

“In the big picture, it would be great if we could just get doctors to tell people they have an option of reconstruction,” Dr. Alderman said.

Yes, that would be nice, wouldn't it? Incidentally, the presentation of options to women with breast cancer also is impacted by the ethnicity of the patient. Cord Jefferson at Stereohyped comments on a study reported in Novermber 2008 in US News and World Report that:

Black women are 47% less likely than other women to undergo breast reconstruction after having a mastectomy... African-Americans have fewer referrals to plastic surgeons, and if they do have a referral, they have a lower rate of going to those referrals. Strangely, even once they see the plastic surgeon, reconstruction seems to be offered with less frequency.

Further, it is important to note that they type of reconstructive surgery performed can impact the effectiveness of subsequent radiation treatment, according to a study cited at Hypography, a science website. In fact, Hypography reports that:

For breast cancer patients who underwent a mastectomy who undergo radiation therapy after immediate breast reconstruction, autologous tissue reconstruction provides fewer long-term complications and better cosmetic results than tissue expander and implant reconstruction, according to a study in the November issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.

One guess which is the most commonly performed reconstructive surgery? (Hint: it involves implants...) Obviously, given the unique circumstances of every brest cancer patient, not everyone will benefit from the exact same procedure, but again, it would be good to hear about the full range of options, wouldn't it?

The Times notes that approximately:

66,000 women in the US underwent mastectomies in 2006... and about 57,000 women had reconstructive breast surgery last year, according to estimates from the plastic surgery society. For many of these women, the operations were more about feeling whole again than about restoring their appearance.

Which brings me to my beef with categorizing this article as one about beauty. I understand that technically, replacing a breast is not medically necessary. Yet the article acknowledges that most women are not doing this for reasons of beauty. American women live in a culture in which our breasts are a large part of what makes us women. While that is appropriate or not as a standard for being considered female, at this point breasts are a critical part of gender identity for many. With that understanding, it is absurd to call reconstructive breast surgery a mere beauty procedure.

MMM at Mage's double whammy diary is also offended by the title:

The title of the article is "The Price of Beauty: Some Hidden Choices in Breast Reconstruction." I find this so irritating. I'm still struggling to articulate exactly what all the issues related to losing a breast are, so it's hard for me to write exactly why this is so galling. It feels misleading, dismissive, and minimizing. It seems to reduce the issues around post-mastectomy breast recontruction down to vanity.

...if I was reading the New York Times on paper right now, instead of on-line, I would take the biggest fattest sharpie I could find and cross out, "The Price of Beauty." In it's place I would write a more truthful, more accurate and more controversial title.

"The Price of Capitalist Health Care: Hidden Choices In Breast Reconstruction."

I could not say it better myself.

Suzanne also blogs at Campaign for Unshaved Snatch (CUSS) & Other Rants. Her first book, Off the Beaten (Subway) Track, is about unusual things to see and do in New York City.