Advocating for affordable breast reconstruction

A breast surgeon at St. David’s Medical Center is helping patients access life-altering care that some insurance providers are refusing to cover. Dr. Elisabeth Potter, who specializes in DIEP flap surgery, is taking on decision-makers in the health insurance industry to ensure safe breast reconstruction surgeries are covered by insurance. 

According to the Centers for Disease Control & Prevention (CDC), after skin cancer, breast cancer is the most common form of cancer in women in the United States. Reconstructive surgery is a common medical procedure for women who have undergone treatment for breast cancer. The surgery often consists of adding implants, which are made of silicone, but it comes with numerous health risks that can result in significant discomfort or pain.

DIEP flap surgery is an alternative to traditional reconstructive surgery during which the surgeon takes tissue from the abdomen (with no damage to the abdominal muscle) to create a new breast. This surgery is much safer and results in fewer complications, but it also requires a very complex surgical technique that is often hard to find. In fact, Dr. Potter is one of the few physicians in Central Texas who is currently accepting patients who require this surgery. 

In 2019, the Centers for Medicare & Medicaid Services (CMS) decided to combine all flap breast reconstruction procedures together under one insurance code and to phase out the unique codes for individual flap procedures by Dec. 31, 2024. Although the coding changes don’t go into effect until next year, many health insurers have already stopped covering DIEP flap surgery.

Dr. Potter is personally fighting to reinstate the insurance code by launching the Community Breast Reconstruction Alliance (CBRA), a coalition to protect safe and affordable breast reconstruction. Members of the community are welcome to join CBRA and help make this surgery affordable for all patients. 

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