Fewer than one in four women are opting for breast reconstruction after a mastectomy, a new study indicates.

In the last decade, 23 percent of almost 109,000 women with invasive breast cancer got immediate reconstruction and 36 percent of nearly 15,000 women with early stage breast cancer did the same.

Whether a woman had insurance was the biggest indicator that reconstruction would follow a mastectomy, researchers said. Reconstruction is covered by Medicare, Medicaid and private insurance, although the copay may be daunting.

“The cost of mastectomy has remained stable, but the cost of reconstruction has increased nearly threefold over this decade,” said study author Dr. Dawn Hershman, an associate professor of medicine and epidemiology at Columbia University Medical Center in New York.

Women may also opt not to reconstruct the breast after a mastectomy to avoid more surgery, said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York.

A surgeon typically rebuilds the breast using implants or repositioning a woman’s own body tissue.