(Reuters Health) Women with breast cancer who have one or both breasts removed are less likely to get immediate reconstruction surgery at hospitals that are struggling financially, a U.S. study suggests.

Most women with breast cancer have some type of surgery – either a lumpectomy that removes malignant tissue while sparing the rest of the breast or a mastectomy that removes the entire breast. After surgery, many of them also receive chemotherapy to destroy any remaining abnormal cells and reduce the risk of cancer coming back.

Compared to women treated at hospitals with few or no financial problems, women treated at hospitals with high levels of financial distress were 21 percent less likely to receive immediate breast reconstruction, the study found.