Breast Reconstruction: Q&A

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Breast Implants vs Tissue Fillers for Breast Reconstruction

I have breast cancer, and will undergo mastectomy, but my insurance will not approve the use of Alloderm for the reconstruction because they say its investigational. If this is the case, what are my other options?

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18 Doctor Answers | Asked by parsons in Bi Gstone Gap, Virginia

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Breast Reconstruction can be done without AlloDerm

If you haven't done so already, talk about this with your plastic surgeon. Breast reconstruction can be done without AlloDerm. AlloDerm is a product made by LifeCell. It is a "regenerative tissue matrix" produced by removing the living cells from harvested cadaveric epidermis and dermis. "The cells responsible for immune response and graft rejection are removed. What remains is a matrix or framework of the natural biological components, which allows the body to mount its... more

Alloderm Use in Breast Reconstruction Post Mastectomy - Insurance Issues

Alloderm (acellular dermal matrix) has been used more than a decade for breast reconstruction and should not be considered investigational. I would appeal the decision and have your plastic surgeon be your advocate and write a letter of necessity regarding its usage in your particular case. Finally, even if you loose the appeal you should only have to pay the cost of the material (cheaper if the surgeon purchase it for you than the hospital which typically doubles (or more !) the price... more

Alloderm is not Investigational

Use of an acellular dermal matrix such as Alloderm has become widely utilized in breast reconstruction. If your surgeon feel that it will provide you with an improved outcome then it should be utilized. It may take a few phone calls and letters, but your insurance company should be able to be educated.

Use of Alloderm in implant-based reconstruction

Alloderm has been used for many years with a proven record. It is not investigational nor experimental. There are many articles that testify for benefits of Alloderm and other dermal matrix. I would have your plastic surgeon be your advocate and contact your insurance company again. Best of luck to you.

Alternative to Alloderm in Breast Reconstruction

Although insurance coverage for Alloderm (and other similar products, called collectively Acellular Dermal Matrix, aka ADM) is becoming more common, some payers may not cover it due to the high cost of the product. If your surgeon feels that you could benefit from it but cost is an issue, a much less expensive option is using Vicryl mesh (same material from which some sutures are made). While it does not have all the advantages of ADMs, it can accomplish the same result for creating a... more

Alloderm in Breast Reconstruction

The use of Alloderm in your implant-based reconstruction plan is NOT experimental. There is ample data to support its use and its is one of the options for breast cancer mastectomy reconstruction. I would speak with your plastic surgeon and have them serve as your advocate. In addition, I would recommend that you contact your insurance company to fight this nonsense. Despite the 1998 federal law mandating mastectomy reconstruction coverage, on occasion, some pesky... more

Alloderm and breast reconstruction

While breast reconstruction has been around for a long time before Alloderm, more and more surgeons are using it for their breast reconstructions. Insurance companies are about saving money. They like to label things "experimental" so they do not have to pay. Remember it took an act of Congress to get them to pay for breast reconstruction at all, and another act of Congress to get them to pay for the other side. Having said that, Alloderm is not... more

Insurance Coverage for Alloderm Use in Breast Reconstruction

Although AlloDerm certainly has a proven track record for use in breast reconstruction surgery, some insurance companies will try to deny it as experimental in order to avoid coverage. DO NOT BE DISCOURAGED! This is when your surgeon needs to be your advocate. 1. The Women's Health Care Act of 1998 requires that any insurance company that covers mastectomy must also cover all stages of reconstruction and matching surgery. 2. Lifecell corporation, who makes... more

Alloderm not approved by insurance

Insurance companies commonly categorize certain treatments or adjuvants as "investigational" and do not cover the cost of using them. Thankfully, most insurance companies are approving Alloderm usage in breast reconstruction due to the large numbers of positive studies regarding its use. If your insurance company does not cover Alloderm, you have a few options: Have your Plastic Surgeon contact the insurance company for pre-authorization - this usually requires a letter... more

David Bogue, MD

6 reviews

Boca Raton Plastic Surgeon

www.drbogue.com

To Use or Not to Use Alloderm

It is unfortunate that you have to deal with this at the time of your reconstruction. This is not an experimental procedure as most of us use some type of dermal allograft to improve the results and the need for further surgeries. The dermal graft bulks up the tissue and seems to decrease hospital stay by making expansion much easier. If your plastic surgeon feels it is necessary to use alloderm type material I would advise your insurance company that this is a necessary procedure and you... more

That "dern" Alloderm

Insurance companies are slowly coming around to cover Alloderm as part of breast reconstruction. If you insurance company will not this not a huge matter because for many years tissue expanders and implant reconstruction was done very successfully without the use of Alloderm. The alloderm provides a bit more control of the final lower breast shape but more importantly in my opinion it adds another layer of protection over the expander and subsequent implant. I hope this is helpful.... more

Alloderm is changing Implant-based Breast Reconstruction

The use of Alloderm and other dermal matrices is really changing the results that are possible with implant-based reconstruction. Although some insurance companies will deny coverage for use of this product, there are cases in which its cost is covered. You should work with your plastic surgeon to appeal the decision by your insurance company. As Alloderm use is becoming more common, reimbursement will likely also become more common.

You can negotiate with the insurance company

You can negotiate with the insurance company with help from your plastic surgeon. For the insurance company it is all about cost reduction, so if your surgeon decides to perform a flap it will cost them much more between hospital stay, fees etc..It is sad that you have to deal with this before your mastectomy but this reflects the nature of the health care crisis we live in. Hope that helps!

Appeal the denial of Alloderm for Post-Mastectomy Breast Reconstruction

If you are denied from your insurance company for dermal matrix in your breast reconstruction, call them and ask why it is being considered experimental. What criteria are they using? Do they pay for another brand of dermal matrix (Alloderm is one brand of dermal matrix). Here in California, for instance, Anthem Blue Cross will only cover Alloderm and considers all other brands experimental (?!). Once you gather this information, file an appeal. There are many published articles... more

Is Alloderm Necessary for Breast Reconstruction?

Breast Reconstruction has been around for over 20 years. Many women have had excellent reconstructions without Alloderm. However, there are reasons that Alloderm has made such a big impact on Plastic Surgeons. Alloderm is not experimental, it has been used successfully thousands of times, and for a good reason. It helps create a better inframmamary fold, a better shape, and a protective covering in case there is any poor wound healing when you are having an implant or Tissue expander... more

Alloderm is relatively new in breast reconstruction

Hello, Insurance companies view procedures relative to financial issues mainly. If they can deny, they tend to deny. Alloderm is useful on occasion in breast reconstruction involving tissue expanders. You can always appeal their decision. Good Luck and Best Regards.

Postmastectomy breast reconstruction with Alloderm is not experimental

Like many surgeons, I've used Alloderm for reconstructive and cosmetic purposes since 1996. My patients have been universally enthusiastic with their results. By contrast, its use for post mastectomy breast reconstruction is relatively new and as a consequence, depending on where you live and who you are insured with, the technique may be denied as "experimental". Like any innovation, insurance companies want to ensure that they are not being obliged to pay for something which... more

Lavinia Chong, MD

22 reviews

Orange County Plastic Surgeon

www.chongmd.com

Breast reconstruction and alloderm

Alloderm is a nice product to use when performing a tissue expander and implant reconstruction. It provides a layer of coverage over the lower pole so that if the skin "breaks down" the tissue expander may not be exposed and the reconstruction can be salvaged. For many years, surgeons did not have this product and still performed the procedures without it. I am surprised though that your insurance company would not allow it. I suggest you appeal their denial