Participants in a public hearing in the Chamber of Deputies highlighted Brazil’s failure to comply with the laws that guarantee breast reconstruction in cases of breast cancer. The subject was discussed this Thursday (28) at special commission created to monitor actions to fight cancer in Brazil, in conjunction with the Committees for the Defense of Women’s Rights and Social Security and Family and with the Chamber’s Secretariat for Women.
Four laws in Brazil deal with breast reconstruction. Law 9797/99 guarantees women who suffer total or partial mutilation of the breast, resulting from cancer treatment, the right to reconstructive plastic surgery in the Unified Health System (SUS). Law 10.223/01, on the other hand, guarantees the payment of reconstructive plastic surgery by private health plans.
Law 12802/13, in turn, determines that, when technical conditions exist, the reconstruction will be carried out at the same surgical time as the removal of the breast. Finally, Law 13.770/18 states that the procedures for obtaining breast symmetry and for the reconstruction of the nipple-areola complex are part of reconstructive plastic surgery.
Disclosure of laws
Deputy Tereza Nelma (PSDB-AL), who is a cancer patient and asked for the debate, highlighted that many women do not even know they have the right to breast reconstruction by SUS and there are cases of women who have waited up to 18 years to get the surgery. “I, as a cancer patient, know how hard it is to look in the mirror and see your breast without the nipple,” he said. As a parliamentarian, she fights for the dissemination of laws. “It is possible to do breast reconstruction at the time of having a mastectomy, and SUS pays. This is our reality. We want to live it,” he said.
Head of the Mastology Service at Hospital Conceição, in Rio Grande do Sul, José Pedrini asked who will pay for the suffering of the woman who waited 18 years for reconstruction. He highlighted that immediate cosmetic surgery, including prosthesis, does not affect the treatment and defended that it should be done in the same surgical procedure, with a single hospitalization.
Pedrini stressed that breast reconstruction at the time of surgery to remove the tumor takes just 40 minutes longer and in 90% of cases it can, from a medical point of view, be done simultaneously. In his view, the woman should be able to make that choice.
Daniela Catunda was one of the cancer patients who reported, in the debate, the difficulties encountered: “I have a group called We Choose to Live, in which 95% of the girls have mastectomies and 95% have not been able to undergo the surgery (reconstruction). it’s too big, the delay is too big, and we have to act with public policies, so that these women can regain their self-esteem,” she defended.
Deputy Carmen Zanotto (Cidadania-SC), who also proposed the debate, stressed that the bottleneck is in financing. According to her, the constitutional amendment to the spending ceiling (EC 95) is limiting the federal health budget, which leads states and municipalities to have to put more resources in the area.
Carmem Zanotto noted that, in health services, it is alleged that, with the amounts paid by SUS, it is not possible to undergo cosmetic surgery. “What the SUS pays does not pay for the prosthesis. If it doesn’t pay for the prosthesis, how are you going to pay the fees and hospital expenses? This has to be our debate,” he said.
Technologist at the Ministry of Health’s General Coordination of Specialized Care, Aline Leal Lopes reiterated that the SUS guarantees the comprehensive treatment of women with breast cancer, including breast plastic surgery.
“In 2019, 1,456 breast reconstruction surgeries were performed by the SUS. We had a negative impact, as is already known by several studies and our surveys in carrying out these surgeries in 2020, on behalf of Covid-19. In 2020, until August , we had 530 held throughout Brazil,” he informed.
Aline Lopes added that the Ministry’s ordinance, dated December 2020, made R$ 150 million available to the states to fund screening actions, early detection and control of breast and cervical cancer in the SUS during the pandemic. But he highlighted that health financing is tripartite, with resources from the federal budget, but it is necessary to have state and municipal counterpart. According to her, each state has its “private issues”.
The breast specialist and coordinator of the Ame-se Program of the Health Department of Alagoas, Francisca Beltrão da Matta, reported that in the state the history is to do a maximum of five breast reconstructions per year. To try to reverse this reality, the program was created a year ago, with the support of parliamentary amendments from Congresswoman Tereza Nelma, and 15 women have already started the process for breast reconstruction.
The debate was part of the Pink October program, promoted by the Chamber’s Women’s Secretariat.