NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A3981
SPONSOR: Jackson TITLE OF BILL:
An act to amend the public health law, in relation to hospital care for
mastectomy, lumpectomy, and lymph node dissection patients
PURPOSE OR GENERAL IDEA OF BILL:
This bill requires that every general hospital that provides mastectomy
surgery, lymph node dissection or a lumpectomy shall provide information
to the patient concerning their options following such procedures.
SUMMARY OF PROVISIONS:
Section 1. Subdivision 2 of section 2803-o of the public health law, as
added by chapter 354 of the laws of 2010, is amended to include the
option of an aesthetic flat closure or going flat, which is recon-
struction of the chest wall contour with no excess tissue after a
mastectomy.
JUSTIFICATION:
The Centers for Disease Control indicates that breast cancer is the
second most common cancer among women in the United States. Women should
be armed with all the information they need to make the best decision
for themselves and their bodies, this very personal decision should
include the option of going breastless or going flat and obtaining an
aesthetically pleasing outcome; an aesthetic flat closure.
A 2021 study released by the journal Annals of Surgical Oncology(1)
indicates that more women are choosing to go flat and opt out of breast
reconstruction after mastectomy surgery. The study further indicates
that for many of those women their decision was not supported by their
surgeon citing older studies indicating reconstruction provided a better
quality of life option for women. In recent years, however, a growing
number of women and advocacy groups have been outspoken about going
breastless or "going flat" and the pushback received from breast
surgeons who have pushed heavily towards reconstruction.
Women undergoing cancer treatment are dealing with enough trauma and
having to also worry about their surgeon going against their treatment
choice should not be part of their recovery journey. In many cases,
surgeons who do a mastectomy with no reconstruction Often leave extra
skin in case the patient changes her mind and then decides to choose
implants. However, this action adds stress and the need to obtain
"revision surgery" to remove the excess skin; sometimes more than one
revision surgery may be needed.
A woman's choice to go flat is very personal and can include wanting to
avoid additional surgeries, feel comfortable with the idea of going
flat, and even looking to avoid additional complications. In October
2021, the FDA strengthened the safety requirements for manufacturers
requiring that patients are warned of possible complications from the
use of breast implants2. This action by the FDA was a direct result of
issues faced by thousands of women after receiving breast implants.
Implants have been linked to a long list of side effects and exposure to
cancer causing materials. The FDA's new requirement ensures patients are
informed of all risks associated with using breast implants. The patient
should be fully informed of all risks to allow them to make the best
choice for themselves.
Another issue faced by women who choose going flat is a surgeon's fail-
ure to provide an aesthetically pleasing outcome after surgery. This
leads to more surgeries, which can be costly for patients who may have
high copayments or may not be able to take time off from work. According
to the recently recognized term by the National Cancer Institute, an
"aesthetic flat closure is a type of surgery that is done to rebuild the
shape of the chest wall after one or both breasts are removed. An
aesthetic flat closure may also be done after removal of a breast
implant that was used to restore breast shape. During an aesthetic flat
closure, extra skin, fat, and other tissue in the breast area are
removed. The remaining tissue is then tightened and smoothed out so that
the chest wall appears flat."
Federal protections are already in place to ensure women undergoing
breast cancer receive the care they need. The 1998 Women's Health and
Cancer Rights Act is the federal law that provides protections to those
who choose to have breast reconstruction in connection with a
mastectomy3. Coverage must be provided for: 1) all stages of reconstruc-
tion.of the breast on which the mastectomy has been performed; 2)
surgery and reconstruction of the other breast to produce a symmetrical
appearance; and 3) prostheses and treatment of physical complications of
all stages of the mastectomy, including lymphedema.
This bill ensures breast cancer patients are informed of their choices,
which include the option to go flat. As more women continue to opt to go
flat, their decision should be respected by the medical professionals
providing care during their breast cancer journey.
PRIOR LEGISLATIVE HISTORY:
2021-22 A.8642 Referred to Women's Issues / S.8232 REFERRED TO WOMEN'S
ISSUES
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
Effective immediately.
(1) Baker, J.L., Dizon, D.S., Wenziger, C.M. et al. "Going Flat" After
Mastectomy: Patient-Reported Outcomes by Online Survey. Ann Surg Oncol
28, 2493-2505 (2021).
(2) October 27, 2021: FDA News Release: FDA Strengthens Safety Require-
ments and Updates Study Results for Breast Implants. Agency adds
restrictions and approves new labeling for all approved breast implants
HTTPS://WWW.FDA.CROV/NEWS-EVENTS/PRESS-
ANNOUNCEMENTS/FDA-STRENATHENS-SAFETV-REAUIREMENTS- AND-UODAT
PS-STUCY-RESULTS-BRPAST-IMPLANTS.ct. implants 3 The
U.S. Women's
Health and Cancer Rights Act, also known as Janet's Law, signed into law
on October 21, 1998 as part of the 1999
OMNIBUS BILL (
PUB.L. 105-277
https://www.govinfo.gov/content/pkg/PLAW-105pub1277/html/
PLAW-105pub1277.htm
STATE OF NEW YORK
________________________________________________________________________
3981
2023-2024 Regular Sessions
IN ASSEMBLY
February 8, 2023
___________
Introduced by M. of A. JACKSON -- read once and referred to the Commit-
tee on Health
AN ACT to amend the public health law, in relation to hospital care for
mastectomy, lumpectomy, and lymph node dissection patients
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 2 of section 2803-o of the public health law,
2 as amended by chapter 571 of the laws of 2022, is amended to read as
3 follows:
4 2. Every general hospital that provides mastectomy surgery, lymph node
5 dissection or a lumpectomy shall provide information to the patient
6 concerning the option of reconstructive surgery following such proce-
7 dures, including both breast and chest wall reconstructive surgery and
8 the availability of coverage for reconstructive surgery, in accordance
9 with the provisions of sections three thousand two hundred sixteen,
10 three thousand two hundred twenty-one and four thousand three hundred
11 three of the insurance law and applicable provisions of federal law. The
12 information shall be provided to the patient in writing and in advance
13 of obtaining consent to the surgical procedure. The information provided
14 shall include at least the following:
15 (a) a description of the various reconstructive options and the advan-
16 tages and disadvantages of each. Such description shall include going
17 breastless or flat and having an aesthetic flat closure as such term is
18 defined by the National Cancer Institute;
19 (b) a description of the provisions assuring coverage by public and
20 private insurance plans of the costs related to reconstructive surgery
21 under federal and state law;
22 (c) a description of how a patient may access reconstructive care,
23 including the potential of transferring care to a facility that provides
24 reconstructive care or choosing to pursue reconstruction after
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07183-01-3
A. 3981 2
1 completion of breast cancer surgery and chemo/radiotherapy, if
2 warranted;
3 (d) such other information as may be required by the commissioner.
4 § 2. This act shall take effect on the first of January next succeed-
5 ing the date on which it shall have become a law.
