I am currently undergoing breast reconstruction after my mastectomy. In January 2012, my left breast was removed. I opted for a mastectomy over a lumpectomy for cosmetic reasons. My plastic surgeon said that I would achieve better cosmetic results this way. Is reconstruction an option for every woman?
The law
The Women's Health and Cancer Rights Act of 1998 (WHCR) states that if you undergo a mastectomy for any reason and your health insurance covers the procedure, then the insurance company must cover the cost of breast reconstruction. Any deductibles and co-payments still apply. The insurance company must also cover the cost of a prosthesis--if you choose to use one instead of having reconstructive surgery. Some insurance companies will cover both--check your policy or call for specific mastectomy and reconstruction benefits.
If you are on Medicaid or Medicare, there may be some limitations. Certain government sponsored insurance policies and some church based insurance policies are exempt from the WHCR. Most individual policies, employer-based policies and COBRA policies must abide by WHCR.
Reconstruction options
Deciding to have breast reconstruction is a very personal decision. Some women want immediate results and opt for a tram-flap or other reconstruction technique using body tissue. Any type of flap surgery involves removing fat, skin and sometimes muscle from one area of the body--like the abdomen or buttocks--and using that tissue to reconstruct the breast. Flap surgery is complicated and has risks, including possible necrosis of the transplanted tissue due to flap failure.
Implants are another option. I decided on implants after doing a lot of research. The recovery time and length of surgery a flap required did not appeal to me. With implants, immediate reconstruction is sort of a misnomer. For me, it meant tissue expanders were put in place during my mastectomy. I will have 10 weekly sessions to fill the expanders. After that, the expanders will be exchanged for implants.
Deciding not to reconstruct is another option many women decide on. Instead of having breasts reconstructed, a prosthesis is used. Special bras have pockets to hold the prosthesis in place. I am currently using a soft, foam and fiber-filled prosthesis until it is time for my expander exchange. Instead of a special bra, I use one from Victoria's Secret that has foam cups. Even under snug fitting shirts, you cannot tell unless you are looking for it. If you choose to go the prosthesis route, explore all of your options. Amazing results can be achieved with the use of silicon or other materials. Some breast prosthesis actually glue on. Specialized prosthesis for swimwear can be worn in the water.
The decision to reconstruct does not have to be made immediately. It is OK to wait until after adjuvent treatments are completed to make this decision. Breast cancer patients requiring radiation therapy or chemotherapy may want to postpone the decision to reconstruct until after they recuperate both physically and emotionally from the treatments. The best time to reconstruct is after you have researched your options and are comfortable with what you want to do.
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