The final remodel of Breast reconstruction. Has anyone had trouble with Insurance coverage?

  • maryne
  • 2 years ago

I had my mastectomy a year ago. Implants in October and this week i'll be having some reconstruction to tidy things up. Then i'll get ready for Nipple reconstruction. Since i had radiation (mammosite) on the right side 4 years ago)  My skin on the right Breast is super tight and lots of scar tissue. My PS wants to do all this liposuction and fixing up of my breasts that I'm worried my insurance company is going to say "cosmetic" but the amount of hanging skin is unsightly.  Has anyone had any issues with insurance denying reconstruction done in stages? And... everyone says that nipple reconstruction is a piece of cake. no pain etc etc. but I have such tight skin on the right side i'm afraid that my results will suck or I'll be back in pain again. PS likes to say I'm the patient he hates the most because he wont get optimal results because of my tight skin. I know what he means because i feel tight ALL THE TIME. so.. any problems with insurance in staged reconstruction and seriously .. the nipples dont hurt??

Comments (3)

I just had (4 weeks ago) breast reconstruction 11 years after my lumpectomy/radiation. A small bit of Liposuction was used. My plastic surgeon dealt with the insurance company and I was charged nothing (but my nipples are very sore-hope this will pas soon).
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The fact that your nipples are sore is a good thing. You retained the sensitvity that many lose during this process. When you have concerns, don't be shy about discussing them with your doctor. It is just part of taking good care of yourself. xo
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Hi Maryne,
WHCRA was enacted in 1998. It requires insurance companies to cover all costs to reconstruct a woman's breast after mastectomy. This includes any procedures necessary to restore symmetry to a woman's body. No time limit on revisions.
The tightness you describe is certainly a challenge for your surgeon as there needs to be enough elastic tissue to allow for closure of any incisions. If stretched too tightly, unsightly scars will ensue and plastic surgeons being artists will have their work cut out for them(pardon the pun). Do you still have sensitivity in the nipple? If so, you may experience soreness, but compared to what you have already been through it won't be so bad.
As soon as your doc gives the OK, it would be a good idea to massage your breasts with an emollient oil or cream(I like bio-oil) and start incorporating some gentle stretching exercises to prevent further scar tissue from reducing your range of motion around your surgery site.
Wishing you the best.
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