BILL NUMBER: S1305

SPONSOR: SALAZAR
 
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
amended by chapter 571 of the laws of 2022, 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.

              

Section 2. Sets the effective date.

 
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 to
also have to 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, feeling 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 implant.(2) 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 failure 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 is 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
mastectomy(3). Coverage must be provided for: 1) all stages of recon-
struction of the breast on which the mastectomy has been performed;
2)surgery and reconstruction of the other breast to produce a symmet-
rical appearance; and 3) prosthesis and treatment of physical compli-
cations 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:

SENATE:

2023-2024: S6866 (Salazar) - Referred to Women's Issues.

2022: S8232 (Salazar) - Referred to Women's Issues.

ASSEMBLY:

2024: A3981 (Jackson) - Passed Assembly, Reported, Passed Assembly.

2023: A3981 (Jackson) - Referred to Health, Reported, Passed Assembly.

2022: A8642 (Jackson) - Referred to Health, Reported, Passed Assembly.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Effective on the first of January next succeeding the date on which it
shall have become law.
(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).  HTTPS://DOI.ORG/10.1245/ S10434-020-09448-9
(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.GOV/NEW-EVENTS/PRESS- ANNOUNCEMENTS/FDA-
STRENGTHENS-SAFETY-REQUIREMENTS-AND-UPDATES- STUDYRESULTS-BREAST-IM-
PLANTS
(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