Can I get RE-Reconstruction being Stage 4?

julierene · 03-21-2006, 09:54 AM

I have bilateral saline implants, and one of them has been EXTREMELY tight since I got it. It's painful, and probably has capsular contraction.

I have wanted the DIEP flap reconstruction since I found out about it because I have children aged 2,5 and 6. But being Stage 4, I am worried they won't cover it or something.

How do I ask?

Lolly · 03-21-2006, 10:25 AM

I'm NOT an insurance expert, and insurance coverage varies from one plan to another, but my first thought would be that you have to start a dialog with your primary care physician about this; the focus should be that it's a HEALTH related issue rather than a cosmetic issue. So you have to have your PCP begin documenting how this is adversly affecting your health, then hopefully you'll get a referral to a plastic surgeon and they usually take up the pre-authorization issue with your insurance.
I know someone who badly needed breast reduction due to very large breasts which were causing back aches and posture problems, and that's how the process went for her. Her insurance covered everything but the process took about a year.

Hope this helps,
<3 Lolly

julierene · 03-21-2006, 10:37 AM

I've complained over and over to my plastic surgeon, and he wants me to wait as long as possible. I think he doesn't feel like any reconstruction will go well because he doesn't offer DIEP flap reconstruction. I don't know, maybe he's worried about the lack of lymph nodes.

The main problem is my right breast implant is PAINFUL! I wouldn't even bother with wanting another surgery if it didn't HURT all the time!

My surgeon though, recommended I take Advil all the time. My Onc doesn't want me to take anything but Tylenol.

Sheila · 03-21-2006, 01:25 PM

Julie

I have the same problem with my left side, silicone implant by Mentor...it is so tight and painful, I know I have developed capsular contracture...but I am almost afraid to have more surgery for fear of "stirring up more bad cells". I had mets to my lymph nodes in the neck and collarbone during my original reconstruction....I had neg nodes at diagnosis....it might not have been the reconstruction but I always wonder....anyway, the cold, moving my arm a certain way, turning the wrong way all sets off the worse muscle spasm across my implant...I wish I had never had it! I know exactly what you are feeling...my choice would be to have it removed and go back to a prosthesis...at least I didn't hurt!

brittd01 · 03-23-2006, 07:12 AM

Hello!

My Mom has bilateral Silicone implants that are killing her too. Her cancer is getting under control but the pain in her breasts is too much. Not sure if they've ruptured or what but she has these painful nodules that her oncologist scanned and mamogrammed, etc. - and were negative for cancer. So she believes it must have something to do with the implants. Do either of you have little painful nodules? She also has the thickening - all of which is painful in both breasts. She also has pain in her arms. What have your oncologists said to do?

Thanks!
Brittany

jessica · 03-23-2006, 08:17 AM

HI~
Just got this in the mail from my insurance company. You may need to do a little more research on The Act, but it may be helpful to you if you pursue some kind of revision of your original surgery.

Good luck!
Jessica

Federal Women's Health and Cancer Rights Act of 1998

The Act states that benefits must be provided for :

*Reconstruction of a surgically removed breast
*Surgery and reconstruction of the other breast to produce a symmetrical appearance
*Prostheses and treatment for physical complications of all stages of mastectomy, including lymphedemas.