By Liz Chong,
It’s breast cancer awareness month. It’s hard not to be reminded of the journey I began since 2022. For just a moment, I had actually forgotten that I was a cancer survivor – a moment of sheer bliss where I’m not worried about the multiple side effects from the hormonal suppression or the endless insurance claims I keep submitting, hoping that they do not get rejected.
As I reflect on this year, I’d like to spotlight an important issue during this Breast Cancer Awareness month: the lack of access to breast reconstruction for breast cancer survivors in Malaysia. The majority of private health insurers in Malaysia do not classify breast reconstruction as part of breast cancer treatment but rather as a cosmetic “want” and not a need. This is a highly discriminatory practice as the majority of breast cancer patients who have undergone a mastectomy are (yes, you’ve guessed it) WOMEN. Even in instances where reconstruction is covered, the full procedure (from hospitalisation to post-op care) rarely is. Typically, a partial coverage of up to 30-50 per cent may be provided at the insurer’s discretion.
Speaking from experience, I had recently undergone my second reconstructive surgery that would otherwise have been impossible without my company’s health insurance (a very special shoutout to my boss – you know who you are :)). I developed a complication from my first reconstruction due to my reoccurrence treatment, and for the longest time, I put off seeing a plastic surgeon knowing that my Malaysian health insurance wouldn’t cover it for the reasons mentioned above. As the months went by, both my oncologist and breast surgeon echoed each other: the pain and discomfort I was experiencing wasn’t going away unless I had another reconstruction done.
Because the lack of private insurance coverage for breast reconstructive surgery is such a well-known reality here, it was even suggested at one point that I should simply remove the implant and forgo reconstruction altogether — a suggestion I knew came from a place of concern due to the pain I was experiencing but one that reflected how limited our options truly are. Also, for context, while public hospitals also perform reconstructive surgeries, wait times can be extensively long.
I have since been fortunate enough to have received 2 reconstructive surgeries over the last 2 and a half years, both fully covered by health insurances. My first reconstruction was done in the U.S. and was covered by my company’s health insurance policy which was bounded by the Women’s Health and Cancer Rights Act of 1998 (WHCRA), a federal law providing protections to patients who opt for breast reconstruction as a result of a mastectomy. Most recently, my international health insurance plan covered my second reconstruction with minimal questions asked. Admittedly, I was worried that it might not be approved as the surgery was technically a complication which originated from my reoccurrence treatment.
Looking back, I realised I had been unfortunately conditioned to expect stringent, gender-biased attitudes toward reconstructive care in Malaysia, where many breast cancer survivors struggle to get their insurance to fully cover surgery, or simply cannot afford it even with partial coverage. It also didn’t help that both my breast and plastic surgeons were initially doubtful that my international insurance plan would approve the claim, though not to be blamed as they had not encountered a health insurance policy like mine before. It’s just another stark reminder that in many ways, these preconceived notions are deeply entrenched in the healthcare system.
Having been able to regain a part of my body that I had lost (twice!), I only feel it’s right that I shed light on this topic so we can move towards a more inclusive healthcare system for all women in Malaysia – one that ensures every woman is provided the opportunity to pursue breast reconstruction if she chooses to do so. Numerous research studies have shown that breast construction improves self-esteem and body image which are important factors in the quality of life of breast cancer survivors.1,2,3 During my first week post-mastectomy, I struggled to even look at myself in the mirror. It felt strange and I was border-line disturbed to suddenly see the area flat. Without my reconstruction, I don’t think I would have picked myself up so quickly – getting back to buy fun clothes (in retail therapy I trust!) and reclaiming some sense of normalcy in a foreign land.
The privilege that was afforded to me should also be extended to every woman in Malaysia. No breast cancer survivor who has undergone a mastectomy — regardless of her age, background, or insurance policy — should be denied the option of reconstructive surgery. My reconstruction journey wasn’t about vanity but about feeling whole again and helping me heal after a traumatic experience. Healthcare systems and insurance companies must recognize that cancer treatment extends beyond survival — it’s about restoring dignity, wholeness, and a sense of self so that survivors can truly live again, not merely exist.
References
- Eltahir, Yassir M.D.; Werners, Lisanne L. C. H.; Dreise, Marieke M.; van Emmichoven, Ingeborg A. Zeijlmans Ph.D.; Jansen, Liesbeth M.D., Ph.D.; Werker, Paul M. N. M.D., Ph.D.; de Bock, Geertruida H. Ph.D.. Quality-of-Life Outcomes between Mastectomy Alone and Breast Reconstruction: Comparison of Patient-Reported BREAST-Q and Other Health-Related Quality-of-Life Measures. Plastic and Reconstructive Surgery 132(2):p 201e-209e, August 2013. | DOI: 10.1097/PRS.0b013e31829586a7
- Jang, Y., Seong, M., & Sok, S. (2023). Influence of body image on quality of life in breast cancer patients undergoing breast reconstruction: Mediating of self-esteem. Journal of Clinical Nursing, 32, 6366–6373. https://doi.org/10.1111/jocn.16621
- Roy N, Downes MH, Ibelli T, Amakiri UO, Li T, Tebha SS, Balija TM, Schnur JB, Montgomery GH, Henderson PW. The psychological impacts of post-mastectomy breast reconstruction: a systematic review. Ann Breast Surg. 2024 Jun 30;8:19. doi: 10.21037/abs-23-33. Epub 2023 Nov 10. PMID: 39100730; PMCID: PMC11296521
