The Impact in an Institute of Social Insurance Coverage for Breast Reconstruction Using Silicone Breast Implants

Abstract

From September 2013, breast reconstruction using silicone breast implants (SBI) was authorized by Japanese social insurance. To understand the impact of this, we performed a study on the number of surgeries related to breast reconstruction one year before authorization and one year after it. The number of total mastectomy (Bt) surgeries increased from 529 out of 1044 to 600 out of 1000, and the number of partial mastectomy (Bp) surgeries decreased from 514 to 399. Primary insertion of a tissue expander (TE) significantly increased from 171 out of 529 (32.3%) to 301 out of 600 (50.2%) . Secondary insertion of a TE also increased from 6 to 43. Contralateral touch up surgeries, such as breast augmentation and mastopexy, decreased. The coverage by social insurance encouraged patients to select Bt and reconstruction rather than Bp with unaesthetic results. This may influence the treatment of breast cancer. In Japan, procedures not covered by health insurance cannot be done simultaneously in the same sitting along with procedures that are covered by health insurance, hence contralateral touch up surgery is not possible at the moment due to the authorization of SBI surgery. To achieve symmetrical reconstruction, such touch up procedures should be covered in the future by social insurance.