Women were less likely to have breast reconstruction surgery after mastectomy if they had Medicaid or Medicare rather than private insurance or if they lived 10 or more miles from a plastic surgeon’s office, a University of North Carolina Lineberger Comprehensive Cancer Center study has found.

Researchers said the findings, published in the journal Plastic and Reconstructive Surgery, highlight additional barriers to breast reconstruction alongside other obstacles that have been identified including race, socioeconomic class and age.

The new data are concerning, researchers said, as they say the procedure can help with self-esteem, sexuality and body image after cancer treatment.