BILL NUMBER: S1305A
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. Public Health Law section 2803-o (2) 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 indicate 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, these very personal decisions should
include the option of an aesthetic flat closure following surgery.
A 2021 study released by the journal Annals of Surgical Oncology (1)
indicates that more women are choosing to opt out of breast recon-
struction 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 aesthetic flat
closures 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 this option, and even looking to avoid additional
complications. In October 2021, the FDA strengthened the safety require-
ments for manufacturers requiring that patients are warned of possible
complications from the use of breast implants. (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 choose the best option 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 protection to those
who choose to have breast reconstruction in connection with a mastectomy
(3). Coverage must be provided for: 1) all stages of reconstruction of
the breast on which the mastectomy has been performed; 2) surgery and
reconstruction of the other breast to produce a symmetrical appearance;
and 3) prosthesis and treatment of physical complications of all stages
of the mastectomy, including lymphedema.
This bill ensures breast cancer patients are informed of their choices,
which include the option of an aesthetic flat closure. As more women
continue to opt for this, their decision should be respected by the
medical professionals providing care during their breast cancer journey.
 
AMENDED BILL:
The "A" print of this bill makes minor changes for clarity.
 
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-SAF-
ETY-REQUIREMENTS-AND-UPDATES- STUDYRESULTS-BREAST-IMPLANTS
(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

Statutes affected:
S1305: 2803-o public health law, 2803-o(2) public health law
S1305A: 2803-o public health law, 2803-o(2) public health law