Understanding your rights, coverage options, and how to advocate for your care
Navigating a breast cancer diagnosis is an incredibly personal journey. When reconstruction becomes part of the conversation, many women find themselves facing a new layer of uncertainty: Will my insurance cover this? What are my rights? Who can I trust to guide me through this next step?
At ARBRA (Arkansas Breast Reconstruction and Aesthetic Plastic Surgery), our goal is to not only provide exceptional surgical care — but to ensure every patient feels supported, seen, and informed. That includes helping you understand how insurance plays a role in your breast reconstruction journey.
Your Rights Under the Women’s Health and Cancer Rights Act
In 1998, the Women’s Health and Cancer Rights Act (WHCRA) was signed into law to ensure that patients undergoing mastectomy have access to comprehensive care — including the option for breast reconstruction.
This federal law requires most group insurance plans to cover the following:
- Reconstruction of the breast removed by mastectomy
- Surgery on the opposite breast for symmetry
- Prosthesis (external breast forms)
- Treatment of physical complications such as lymphedema
- Nipple reconstruction and tattooing, when appropriate
For many patients, this legislation quietly safeguards something incredibly meaningful: the right to feel whole again.
Choosing Your Own Reconstructive Surgeon
What many patients don’t realize is that you are not limited to the surgical team involved in your cancer care when it comes to reconstruction. You have the right to choose your own plastic surgeon, even if you delay reconstruction for weeks, months, or years after your initial treatment.
At ARBRA, we frequently care for women who are seeking second opinions, exploring new reconstruction options, or returning for a delayed procedure after time has passed. Whether you’re exploring DIEP flap surgery, implant-based reconstruction, or revision, our team is here to support your choice — and walk with you through it.
Questions to Ask Your Insurance Provider
Because every insurance plan is different, we encourage patients to contact their providers directly and ask a few important questions:
- Is breast reconstruction after mastectomy covered under my plan?
- Does my plan cover natural tissue (autologous) reconstruction methods like DIEP flap?
- Will I need a preauthorization or referral for surgery?
- Are surgeries for symmetry or revision included?
- Are there in-network vs. out-of-network cost differences I should understand?
We always recommend writing down the name of the representative you speak with, noting the date, and requesting a summary of your benefits in writing when possible.
When Coverage Isn’t Always Clear
While federal law mandates coverage for reconstruction, how that coverage is applied can vary depending on your plan. For example, some plans may approve certain types of reconstruction but request documentation or prior authorization for others. Others may offer full coverage for symmetry procedures or stage-based revisions, while some may limit coverage to the initially affected side.
At ARBRA, we help guide you through this process. Our team works directly with your insurance provider when possible to clarify benefits, provide required documentation, and ensure you’re fully informed before moving forward.
Considering Reconstruction After Time Has Passed?
One of the most common questions we hear is: “Is it too late to have reconstruction?”
The answer is no. Whether your mastectomy was last month or ten years ago, you still have the right to pursue reconstruction. Many women choose to delay their decision until they’re emotionally or physically ready, or until they find a team that makes them feel heard and supported.
At ARBRA, we honor that timeline. We’ve helped countless women who initially opted out of reconstruction, only to later decide that they were ready to explore what’s possible.
Our Commitment to Advocacy and Support
Insurance conversations can feel overwhelming, especially in the midst of recovery and decision-making. But you are not expected to navigate this alone. We believe patient advocacy is a part of care — and we’re here to help ensure your questions are answered and your path forward is clear.
Our role is to walk alongside you, not just in the operating room, but throughout your entire healing process — including the paperwork, phone calls, and preparation that come with it.
Ready to Learn More?
Whether you’re preparing for surgery, seeking a second opinion, or exploring reconstruction for the first time, we invite you to connect with our team.
Located in Springdale, Arkansas, ARBRA is home to fellowship-trained plastic surgeons who specialize in both implant-based and natural tissue breast reconstruction. We are proud to serve patients across Northwest Arkansas and beyond, and we are honored to be a part of your journey.
Contact us today to schedule your private consultation at (479)-322-4244 or
Click the link for our consultation request form: Here
