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Global Disparities in Insurance Coverage of Post-Mastectomy Breast Reconstruction
Aiman Perween Afsar1, Barbara Mullen1, Andrea A Moreira2
1Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
Annals of Surgical Oncology
|June 27, 2026
Summary
Geographic and socioeconomic factors significantly impact post-mastectomy breast reconstruction (PMBR) access globally. Insurance coverage variations are a primary driver, necessitating policy interventions to improve equity in breast reconstruction services.
Area of Science:
- Oncology
- Plastic Surgery
- Health Services Research
Background:
- Post-mastectomy breast reconstruction (PMBR) is crucial for physical and psychosocial recovery after cancer treatment.
- Significant global disparities exist in accessing PMBR, influenced by geographic location and socioeconomic status.
- Insurance coverage is a major determinant of PMBR utilization rates worldwide.
Purpose of the Study:
- To examine regional variations and disparities in post-mastectomy breast reconstruction access.
- To identify the role of insurance coverage in influencing PMBR utilization across different global regions.
- To inform policy recommendations for improving equitable access to breast reconstruction.
Main Methods:
- Systematic review of English-language literature.
- Searches conducted via PubMed and reference screening.
- Analysis focused on regional insurance disparities and PMBR access.
Main Results:
- PMBR utilization varies widely: Africa <10%, Asia (South Korea 77%, China/India limited), Europe/Australia/NZ/Brazil (universal coverage, variable use), North America (US mandates, disparities; Canada universal, underutilized).
- Out-of-pocket payments are dominant in low-access regions like Africa.
- Affluent urban populations have better access in countries with limited insurance coverage.
Conclusions:
- Insurance coverage is a critical factor in achieving equitable post-mastectomy breast reconstruction access.
- Targeted policy interventions, including legislative mandates and rural outreach, are needed to bridge access gaps.
- Improving guideline-based surgical counseling can enhance PMBR utilization and patient outcomes.