Breast implants to get insurance coverage

Breast implants used in reconstruction treatment after a cancer operation will be covered by medical insurance starting next month, a health ministry panel decided Wednesday.

It is the first time in the nation that coverage of treatment after total breast removal was approved.

The decision is expected to significantly reduce financial burdens on patients who have had to pay as much as 1 million yen for uninsured treatment.

The Central Social Insurance Medical Council of the Health, Labor and Welfare Ministry approved health insurance coverage for breast implants made by Allergan Inc. of the United States, priced at 69,400 yen. Patients will shoulder 30 percent of the cost.

Coverage for a tissue expander that stretches skin to insert a breast implant, priced at 32,100 yen, also was approved. Use of the products based on the Pharmaceutical Affairs Law was approved in September.

Under the health insurance system, patients are entitled to refunds for payment to hospitals and other medical institutions that exceed certain levels. The maximum monthly amount a patient has to pay is about 80,000 yen for those with an average yearly income.

The move to cover breast implants is thus expected to largely reduce the financial burden on patients.

In Japan, where about 60,000 people develop breast cancer annually, 20,000 are believed to undergo breast-reconstruction surgery after the removal of one or both breasts.

While reconstruction using breast implants is not covered by health insurance, treatment using natural tissue such as muscle, fat or skin from the stomach or back is.

Although the latter method is more natural and less expensive, it makes use of healthy body parts, putting physical strain on patients. Surgery using breast implants does not require such recourse, as skilled plastic surgeons can give the breasts a natural shape.

One problem with breast implants, however, is that patients may feel the silicon is uncomfortably cold, and they are obliged to shoulder large financial burdens.

The artificial breast that was approved to be covered by health insurance is an older-model, round silicon type. The use of newer, more resilient, teardrop-shaped implants that give the breast a more natural shape is now being studied based on the Pharmaceutical Affairs Law.

The tissue expander, the newest of its kind with a natural teardrop shape and the lowest risk of infection, was approved.

Ayako Mizoguchi, who leads KSHS (Kichinto Shujutsu, Honne de Saiken), a group that shares breast cancer experiences and information among patients and others, said the latest move gives hope to people who lost a breast due to cancer, as some of them cannot afford breast reconstruction treatment.

"I'm concerned about the look of a breast after reconstruction using the approved product, since it is an older model. I want the new implant to be covered by health insurance soon," said Mizoguchi, who has launched a petition to have breast reconstruction products covered by national health insurance.

Insurance lagging

While it is great news that a means of alleviating the feeling of breast loss through implants will be available to many women, only older-model artificial breasts are to be covered by insurance.

"Even if an insurance claim [for breast implants] was accepted, I would find it hard to use them when I think about whether they will make a patient happy," said Yoshiko Iwahira of Breast Surgery Clinic in Tokyo.

Mastectomies as a preventive measure against hereditary breast or ovarian cancer, as well as subsequent breast reconstruction, are not covered by regular health insurance. Actress Angelina Jolie recently underwent the process, bringing it into the spotlight.

For many years, artificial breasts were not covered because their safety has been repeatedly questioned. Not enough has been done in Japan to improve the situation. Authorities fail to grasp what types of breast implants have been used and how many, as doctors import breast implants themselves.

Still, safe and inexpensive use of breast implants in this country is finally becoming a reality. The government has instructed academic societies concerned to compile safety guidelines for artificial breasts.

It also set standards for facilities and doctors to perform breast reconstruction, making relevant training mandatory, and asked breast implant manufacturers to conduct a long-term study on users.

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