Sunday, November 3, 2013

9 Months Post-Op

I had my 9 month check up with the breast surgeon. It was a short visit. All is good. She said come back in a year. I asked "Why?" She replied that she usually did follow ups for a couple of years. I politely declined and she had no problem putting me on an "as needed" status. I have one less thing on my to do list and one less bill to burden the medical system. But most importantly there are way too many other women who will truly need that appointment with my breast surgeon - sadly.

I scheduled my gynecologist appointment this week. I am nervous. I will feel much better when that pap smear comes back clear.

Now I have a bit of a Rant ...

Mastectomy without Reconstruction (Simple Mastectomy)

Mastectomy without reconstruction or "simple" mastectomy is removal of the breast tissue and overlying skin including the nipple/areolar complex, via an elliptical incision, usually leaving a transverse or oblique scar.

Whilst post operative photographs are usually readily available as a resource for women undergoing breast reconstruction, there are often few images available for women undergoing mastectomy without reconstruction. The multiple images below demonstrate the varied cosmetic results that may follow simple mastectomy, related primarily to operative technique and the body habitus of the patient.

Cosmetically sub-optimal folds of flesh at the side of the body or 'dog-ears' are frequent following mastectomy. Redundant skin and fatty soft tissue at the outer end of a mastectomy scar can be unsightly and uncomfortable. 

I have some excess skin and small dog-ears. On the advice of my breast surgeon, I have an appointment with a plastic surgeon. If it is a simple procedure to remove then I may consider doing it. If not, then I can definitely live with my bumpy chest.

I did get slightly agitated when the plastic surgeon's nurse advised that insurance would not likely cover the procedure if I decided to proceed. I asked "Why?" She said they do not usually cover it "just to improve how it looks." I do not quite follow the logic of how a full breast reconstruction would be covered if I asked for it right now but removing some excess skin would not? Pretty sure both fall into the category of "improving how it looks." I am also certain that there is a significant cost differential. So tomorrow I will call my insurance case worker and discuss with her. It will be interesting to hear what she says.

The glorious thing about breast cancer awareness is that typically everything you could possibly need is covered by insurance including life saving treatments, camisoles to hold your drains, physical therapy, special bras and multiple types of reconstruction. It does not feel right that the same level of coverage and attention would fall short for women who decide to go breast-free. There are amazing plastic surgery techniques to reconstruct breasts with beautiful results. So how can there not be surgical techniques to avoid or insurance coverage to fix what you see in those photos?

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