Tag Archives: Plastic surgery

Bralooza

Do you know that most insurance providers (in the US) cover post-mastectomy bras for women who have undergone a mastectomy? There are limitations, deductibles and co-pays still apply, and you might have to jump through some hoops. More info below photos.

I get six bras and six camisoles per year under my current plan. I recently visited a local mastectomy boutique for a fitting and left with four Coobie bras, two Anita bras, and two camisoles (+ third on order). I will return in the spring when Amoena releases new colors and styles to pick up three more camisoles. The experience was relatively hassle-free and since I already met my out-of-pocket maximum for the year, they were all covered at 100%.

How does it work?

I started by calling my insurance provider to check level of coverage and to request a list of providers. Post-mastectomy bras are considered medical devices (the code is L8000), so I got a list of places that sell all kinds of devices, which didn’t really help. Then I contacted a local mastectomy boutique: 1. to ask if they work with my insurance provider, 2. determine what I needed to do before I came in, and 3. to make an appointment. I provided my surgeon’s contact information and my insurance details. The boutique reached out to my plastic surgeon and obtained the required prescription and details. They also contacted my insurance provider and secured pre-authorization. A week later I got a call that all was set. They really made it easy.

Some insurance providers work with stores like Nordstrom (appointment required). Those that don’t may reimburse after the fact. Also, stores carry different stock, so if you want Coobie bras, you may need to call around. Keep looking until you find a place that works for you. There are options. Nordstrom will even remove underwires for free (so I hear).

There are providers out there that post their policy online and you may see caveats such as “covered instead of reconstructive breast surgery” or that a breast cancer diagnosis is required. Don’t give up. You may still get coverage if your surgery was prophylactic and you chose to complete reconstruction. You could be asked to prove medical necessity though. The insurance department at the boutique will help you with this. However, if your provider does cover these, keep in mind that your deductible and co-insurance may still apply. Also, they may only cover “basic” bras, so no bejeweled magic lifting contraptions. 🙂

PICC life

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nofuncity Greetings from NO FUN City

It has been four weeks since I got the PICC (peripherally inserted catheter). That’s how long I have now been on IV vancomycin. I have been cranky and frustrated.

Why?

Following my most recent surgery two months ago, I developed a spot of redness. The cause was a mystery. No fever, swelling, discharge, or open wound. An ultrasound didn’t tell us much.

Suspecting an infection, my doctor and I agreed that antibiotics were the way to go. Two different oral types didn’t help, so we moved to the big gun, vancomycin, which is a broad spectrum antibiotic often used to treat staph. I was willing to try anything to avoid another surgery and potential implant removal. Been there, don’t want to do that again!

How?

The vanco would be delivered intravenously, so I visited the hospital’s intervention radiology department and had a PICC inserted into my upper arm. I was told I would not need to be hospitalized for this treatment and sent on my way. Later that day I had a delivery of supplies and meds (holy moly, it was a lot of stuff). In the late evening a nurse came to hook me up to my new best friend. I chose to have an electronic pump deliver the meds on a programmed schedule, rather than administering the doses myself. This meant I would be lugging it all around with me 24/7.

My fridge was full of meds and my dining room table became the supply station and the place where every couple of days I sat with nurses that visited me to draw blood and change dressings. Over the course of four weeks I had 79 infusions and 13 visits by 7 different nurses. For showers, I had to plastic wrap my arm and bathe using only the other one.

PICClife

Initially this was a two week gig, but when the progress wasn’t satisfactory, we extended the treatment for another week, and then one more. Throughout I kept my doc updated via emails and photos. There were a few office visits in there too. My insurance covered all this at 100%.

Now what?

Although initially we saw improvement in the redness, a new spot developed in another area, and some days it was angry red and others not. Right now the spots are faint, but still there. After four weeks of treatment, we did a status check and weighed the options:

Continue treatment
Stop treatment and keep a close eye on it
Go in there to get a tissue sample and send for cultures

At this point, I am not confident that what we are doing now is really helping, so we are going with #2. It is possible this isn’t an infection. We discussed this at the very beginning, but then it seemed like the best explanation. Since I had no open wound, we weren’t able to get swabs for cultures and I was not a fan of going in there as mentioned above. If this was an infection, the vanco would’ve nixed it by now. What exactly is going on, we don’t know for sure. It may be happening due to the physical stress on the tissue or some other thing we haven’t thought of. My body is weird … the various complications from the last three years are proof.

But for now, I am free of the pump and bag! To celebrate, I had lunch with friends and went bathing suit shopping for an upcoming trip to Punta Mita, Mexico. I can’t wait to lay on the beach and think about my next margarita instead of my next infusion. Fingers crossed that this will resolve over the coming days/weeks. It’s the last hurdle before I cross the finish line.

Srsly?

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At this point, I don’t really know what to expect. Is this ever going to end? I have already lost an implant twice: one year apart, one per side, both a month out from exchange surgery, but for different reasons. I am 3.5 weeks post-op and worried.

michaelscottnooo I’m paranoid at this point, so I check things over a couple of times per day. Two weeks after my exchange surgery, I noticed a new spot on my right breast, the one we just exchanged. Part of it was hidden underneath the hypafix tape that was still hanging on, so I removed that to investigate what was going on underneath it. It was below (but not including) my incision, about an inch in diameter, and red. #FML #WTF #SRSLY. Please, not again! That familiar feeling of dread washed over me. I sent photos to my plastic surgeon looking for some feedback and reassurance. The response began with:

“I doubt this is anything serious, but with you, one never knows. …”

We emailed a bit more and a Bacrtim (antibiotic) prescription was called in to my pharmacy. Fast forward a week: the spot is still there! Some days it is darker and wider than others and I’ve been keeping my PS updated by email. I am now seeing a hint of blue, which is not a good sign. This is really deflating, but I am really trying to keep my shit together and take it one day at a time. This sums things up nicely:

“Your breasts do not make sense. I remain hopeful and a little concerned. …”

I completely agree: this does not make sense! It popped up 2 weeks after surgery, I have not been using any products on the skin, I am not wearing bras or tight clothing, there are no other areas that look like this. Is it an infection? I’m back on Bactrim for over a week, why isn’t it going away? Do we need to switch to something else? Or do I just sit and wait? I go in to see the PS on Monday.

On top of that, I discovered a lump in the same breast at about 11 o’clock. We are both puzzled by it and can’t explain what it is. It was not there before surgery and Dr. M didn’t note any lumps while he was in there during surgery. Maybe it’s another stitch knot, not yet dissolved (one of these little assholes cost me an implant last time). He suggested that it may be a surgical staple, but not 100% sure if those were used; there’s nothing about them in my post-op report. My immediate concern is the suspicious red spot that won’t go away. To be continued …

Happy ending?

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WARNING: NSFW / graphic content below.

One week after exchange surgery, during which my right tissue expander was replaced with an implant, I am feeling fantastic! My recovery has been going very well and I like what I see. The surgery took a few hours; I was home by 2pm. I left the hospital in a bra and with a drain exiting my right armpit. I suspected I would have one, so while still a big bummer, it was not a surprise. The pain level was low overall (maybe a 3). The following days were uneventful. I spent the weekend home alone, mostly reading and sleeping.

Pain Scale

Although my level of activity was low, drain output was 80mL for the first couple of days, so it had to stay in a bit longer. During my second follow up appointment, on Monday, the drain was removed. About a foot of tubing, which was placed in the pocket around the implant, was pulled out (see pic on right: from the black stitch just under the hand, all the way down!). This is usually not painful, just weird. Good riddance! Feeling so much better with that thing out of me. Dr. M declared that things were looking good and ordered a follow up a week later.

So, how are things looking? You tell me!

Mentor round, smooth, high profile, silicone in 450ccs. Left in pic: 1 week, right: 10 months.

I am still swollen and bruised (Arnica helped), but the result is pretty darn good, considering the circumstances. I’m hesitant to celebrate, however. With my history, I have a few more weeks to go until I can breathe a little easier. The issues I experienced after my last two exchange surgeries (see: Houston, we have a problem and Déjà vu) both happened about a month out. So, fingers crossed that this is my happy ending! I can’t wait to move on with my life.

Tissue expansion

What is tissue expansion?

Reconstructing the breasts after a mastectomy can be achieved in a few different ways, including using tissue from other areas of the body or breast implants. In some scenarios chest skin and muscle are first expanded (stretched) before the breasts are reconstructed. A post from a couple of years ago further explains how this works:

Tissue expanders, which are like “pre-implants” (pictured on left), are inserted underneath the pectoralis major muscle. They are similar in shape and size, but are more rigid, unnatural, and uncomfortable. A round magnetic port in the top half allows for insertion of a needle, without compromising the expander. The tissue expanders are slowly filled with saline to stretch said muscle and the skin that covers them, until the desired volume is reached.

Breast Reconstruction Guidebook Figure 7.1

The process of filling the tissue expanders is pretty quick and uneventful. First the nurse uses a little plastic contraption with a metal pin at the end to find the magnetic port in the tissue expander. Once the center of the port is identified, the nurse sanitizes the area and injects the needle attached to a syringe holding the saline. She then slowly pushes the plunger until all fluid has been injected into the expander. This takes less than one minute. After completing the fill, she places a little round band-aid over the injection site. The end. This procedure itself is painless.

The hours or days after a fill, however, can be uncomfortable and this will vary from one fill to the next and from one woman to another. Some women have no pain at all, some experience a gradual increase in pressure and pain, and some are surprised going from one completely painless fill to another one that knocks them off their feet. During round one I was fine until about fill 6, which was not fun. Days after 7 were so uncomfortable, that I split fill 8 in two. Some women take muscle relaxers or pain meds before their appointments.

Here are a couple of great videos explaining the process:

Source of Figure 7.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

Long road of expansions ahead

So it goes

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It has been two years since I had my prophylactic bilateral mastectomy. January 22, 2013 was the day. At the time, I expected the breast reconstruction process to take somewhere around six months. Well, two years later I am uniboobin’ it once again and it will be at least another six months before I will have my next (last?) exchange surgery.

So it goes.

This process has not been easy. I’ve hit a couple of significant snags, but I still say this: I WOULD DO IT ALL OVER AGAIN. Knowing what would come my way, if I had to go back in time and contemplate moving forward, but not being able to change anything, I would make the same decision and do this all over again. I won’t lie, I have had bad days. They don’t come often, but they do. On those days I choose to take a deep breath and focus on the big picture and the positive. I consider the reason why I made this decision in the first place. I said NOPE to breast cancer and I would do it all over again. I choose to accept and look forward. So it goes.

Attitude

Here’s a recap of my procedures:

01/2013 – Prophylactic bilateral mastectomy with tissue expander placement
09/2013 – Exchange surgery
10/2013 – Infection and left implant removal
04/2014 – Expander placement and revision surgery
09/2014 – Exchange surgery
10/2014 – Right implant removal

In just a few days, on January 27, I will have surgery #7. During this procedure, Dr. M will be placing a tissue expander on my right side. Over the coming months I will again go through the expansion process until I reach 550ccs. My exchange surgery is scheduled for July 23. I feel like I’m a surgery pro at this point. The coordinator from the hospital called today and we very briefly talked about logistics of the day of surgery. She remembered talking to me before and admitted I received the condensed version of the spiel. Fine by me. I know the drill by now. I’m ready to go! Last thing to do is review my handy dandy surgery prep checklist and gather a few items.

Will I have a drain again? Will everything go OK? Will I have any more complications? I hope not, but if I do … so it goes. Shit happens. We deal with it, because we have to. Happiness (or misery) is in the heart, not in the circumstances.

You’re up

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I got the call. Woo hoo! I got the call that made my day. It really made my month. There has been a cancellation and an earlier spot is available on Dr. M’s calendar. I’ve been bugging the Patient Care Coordinator for a few months now and have been at the top of the cancellation list, so the spot is all mine. My next surgery has been moved up to January 27!

That’s only two weeks away! I am ecstatic. Thee months into the six month wait, but I’ll take it!

During this surgery we are going to be placing a tissue expander on the right side, where we had to deconstruct after the last incident in October. I also got the exchange surgery penciled in for July 23. I’m at the top of that cancellation list too and may be up sooner. There is a slight chance that I’ll go right to implant and not need surgery #8, but I’m not holding my breath.

That is all. Just this awesomely good news. 🙂

Yep, looking good

Fin!

4 Replies

WARNING: NSFW / graphic content below.

Alright boys and girls .. I think we did it! I think we’ve finally arrived at the end. My exchange surgery was on Thursday, September 11. I had pocket revision on my right side and a swap from tissue expander to implant on my left.

Sunrise We arrived at the hospital at 6:30am for the 8:30am procedure. It was a beautiful morning! The surgery lasted three and a half hours – longer than we expected. I woke up bundled up in a tight compression bra and ACE bandage wrapped about my chest. The biggest and most wonderful surprise: NO DRAINS!!! I couldn’t believe it. Spent a bit in the recovery room and then hightailed it home to my comfy bed.

On Friday, we drove out to Dr. M’s office for my follow up appointment, which is when I got to see them for the first time after surgery. Things are looking good! I do have some swelling, which is to be expected, but aside from that they look to be the same size, are even on my chest wall, and my nipples line up. Woo hoo! I know it’s early, as it takes up to a year for things to settle, but I am just ecstatic!

Dr. M explained what he found while he was in there. It appears that at some point since my last surgery in April I ripped apart the pocket revision he did then and this is why the right side was bottoming out again. This could’ve happened as I bumped into something or fell or had some other physical strain or trauma. Hub pointed out that it may have something to do with me painting. Yes, I admit, I did more than I should have. I’m an idiot. This time around I am doing N O T H I N G. Absolutely nothing. For at least a month. And no excuses!

On my left side, Dr. M made the incision underneath the nipple, where the original was, rather than going in through my armpit again. He had to do some work on that side to make sure symmetry was achieved, hence a bit more swelling there. He did not do any fat grafting, which made me happy and I did stay with the same implant size and projection I had previously: Mentor round, smooth, high profile, silicone in 450ccs.

I am feeling amazing! I think the girls look great and physically I am not in too much pain. I am to wear this compression bra for two weeks straight, with the exception of showering. This will ensure everything heals in place as it should. Next appointment: September 25.