Global Disparities in Insurance Coverage of Post-Mastectomy Breast Reconstruction.

Abstract

Post-mastectomy breast reconstruction (PMBR) plays a critical role in restoring physical appearance and psychosocial well-being. However, pronounced geographic and socioeconomic disparities in PMBR access persist worldwide, largely driven by insurance coverage variations. We reviewed English-language literature examining regional insurance disparities in PMBR access through PubMed searches and reference screening. Access to PMBR varies dramatically across regions. Africa demonstrates the lowest utilization; fewer than 10% of eligible women undergo reconstruction, primarily through out-of-pocket payments. In Asia, South Korea's national insurance coverage achieves 77% PMBR rates, whereas limited coverage in China and India restricts access to affluent urban populations. Europe, Australia, New Zealand, and Brazil provide universal coverage with variable utilization. North America demonstrates legislative mandates in the United States, yet socioeconomic disparities persist, while Canada offers universal coverage with underutilization. Policy interventions requiring legislative mandates, guideline-based surgical counseling, and rural outreach are essential to address these equity gaps.