Hello Health Insurance, Goodbye 34KK Boobs! Finally! Boston, MA

A few days before my pre-op, I was called by the hospital where my surgery will be performed. I confirmed the details, and was given a list of information:

> No NSAIDs or aspirin for the foreseeable future. Tylenol is okay if absolutely necessary.
> No booze for 48 hours prior to the surgery
> No recreational drugs either (didn't apply)
> No taking supplements of any kind, including vitamins. Avoid foods high in Vit E as well.
> Absolutely no eating or drinking after midnight the day of the surgery. This is for the anesthesia. If they find anything in your stomach they may postpone the surgery.
> To find out the time of the surgery, I can call after 2:30pm the day before, if I haven't heard from them already. (I was told the time at my pre-op, but I'm going to call to confirm nonetheless.)
> Wash with Hibiclens the night before and the morning of the surgery. Spend at least 3 minutes on the area to be surgerized.
> Don't put any lotions/deodorant/etc on the morning of surgery, and leave all jewelry at home, as swelling is a potential risk.

The lady also asked about anything I've been diagnosed with or anything that might affect the surgery. I tend towards tachychardic so I let them know and she made a note of it.

The actual pre-op appointment was pretty uneventful. Dr Lin was called away to an emergency surgery so I ended up watching General Hospital in the waiting room for an hour and a half. The actual appointment was about 10 minutes. We exchanged pleasantries and he reviewed my file as we talked.

First thing he said was "So you got approved? Good." Considering my surgery had been scheduled for almost a week at this point, this made me a little annoyed but I let it go. I'll put a list of the questions I got answered below, but the main thing I wanted to discuss at the pre-op was what size he'd be bringing me down to. As I previously mentioned, I'd said "about half" at the consultation and the assistant had put down a D cup (what does that even meeeaan??).

When I asked this time around, he said again, "Well, I don't want to speak in cup sizes as every manufacturer is different" (not significantly so if you know what you're doing, but okay)

So I asked if he could give me a ballpark range for how much he plans to remove. The rejection letter from the insurance mentioned about 600 grams from each side. Dr Lin said, "Oh that. That's just for the insurance minimums. We haven't decided how much we're going to remove."

Getting more frustrated, I asked when we'd do the drawings on my boobs. He said the morning of the surgery. I pressed that I'd be able to have input, and he said yes.

I'm not super attached to any one size, so I'm not really worried. But still. I get that he hadn't seen me in almost 3 months and that he'd just come from an emergency surgery, but we shouldn't have had the post-op then if he wasn't prepared for it! The only thing I'm worried about at this point is if they dope me up before the drawings are done, as I've heard was the case for some other ladies. I fully plan on refusing any drugs until I see him and we discuss it. I'm not great at being confrontational, but this is important.

Afterwards, I received a packet of information from the admin and my Percocet prescription. I scheduled my first follow-up and was told the surgery would be at 9:30am so to get to the hospital at 8am.

As part of the packet I was given an emergency/after hours line to the hospital as well as the nurse's number. This put a lot of my fears to rest about Dr Lin being hard to reach. I don't need to be able to reach him specifically, just someone who knows what they're doing in case I feel something's gone wrong.

Here's the other information I gathered:

- There aren't any dietary restrictions before or after the surgery. I'm still following a high fiber/high protein diet for now to make the inevitable constipation less of a hassle and to speed recovery.

- I'll be given a surgical bra at the hospital, and I can buy front-closing sports bras to wear afterwards. (Side note: I checked Target, CW Price, and Marshalls and NOBODY has front-close bras of any kind. Ridiculous!) (Side-side note: Marshalls did have 32GG Panache t-shirt bras for $3.00 on the clearance rack. Holy crap! Panache in my current size doesn't work with my shape as the wires are too wide, but that might be different in smaller sizes!)

- I told him I didn't play well with hydrocodone so I was prescribed Percocet. I got this prescription right away (after asking if I'd be forced to go to a pharmacy immediately after surgery, as the hospital itself won't fill prescriptions).

- OTC stool softeners are fine to take beforehand and after. I can take any supplements I want after the surgery. Antihistamines are fine as well.

- I won't be prescribed anti-nausea meds or patches. I've never had surgery before so I don't know how I'll react to the anesthesia. We shall see!

- He uses Steri-Strips so I'll need to wait until those just fall off. The first post-op will be a week after, as there aren't any drains. I won't be given any ointment, but as soon as the incisions are 100% closed I can go to town.

- I should wear a zip-up or button-up shirt the day of surgery and other comfortable clothes.

- I'll be given general anesthesia only; no local.

- I will get to meet the anesthesiologist beforehand and ask any questions.

- Dr Lin said the surgery will take 4-5 hours, which is on the long side from what I've seen. Granted, it's a huge job. There's a lot of boob. I also hope it means he takes his time and is detail-oriented.

- As it's so long, I'll almost definitely have a catheter put in. :( At least it will be removed before I wake up!

- He'll use dissolvable stitches so the healing should be pretty self-sustaining for the first few weeks.

- Small openings, especially at the T juncture, are common, but I should be worried if I have a fever or notice any asymmetrical/lopsided swelling.

Next up.... the surgery! OMG!

Backstory -> First Consultation

I've had a sizeable rack since I was about 11 years old. I'm 23 now. After learning how to properly fit a bra 3-4 years ago, losing some weight (that I later gained back, but hey, it happens), and getting the chance to go to a chiropractor for a while, most of my back problems receded, but they still required constant management. I had to make sure to sleep a specific way; I couldn't put my jacket on wrong; I couldn't sit at my sewing machine for longer than an hour or two; etc.

I got a new job in Boston last year and it came with some freaking amazing health insurance (NHP PPO), so I finally decided to get seen about these things. I wasn't 100% sure if I wanted a reduction, but I wanted to explore the possibility. The increase in stress from my job and moving ended up exacerbating all of my symptoms - headaches, numbness in my hands/arms, pain from my waist up, rashes, etc. My management techniques had been pushed to a lower priority by the sudden change and I realized I couldn't live like this anymore. I needed to be able to handle normal life changes without being hobbled by pain.

I asked my PCP for a referral and she put in the request, and told me to pick out who I wanted at a later date. I only ended up seeing one surgeon, as I was mostly comfortable with him and the other one I was looking at required a $150 consultation fee. Dr Lin was professional and didn't speak to me in cup sizes, which I appreciated. (His assistant did though -- when asked what size I wanted to be, I said, "About half of what I am now" to which she responded, ".............. so a D?" sigh. I understand that something needed to be written on the form, but it still made me uncomfortable.) Dr Lin definitely suffers from the typical busy doctor move-along attitude, but he was never rude. The most important thing to me was that his before and after photos were good (although there were not that many in the file he showed me) and the fact that all research showed him to be good at his job.

At the consultation last November, we discussed some of my symptoms and took photos. I didn't have much medical documentation to speak of (my chiro visits and my physical from two weeks before was all there was since I was 9, really) but he didn't ask about any of that. In any case, I'd had my chiropractor fax over my history a few days before the appointment. The whole thing took about half an hour and he explained what he would do. He doesn't use drains and almost never does free nipple grafts, which made me happy to hear. I asked some other various questions that, in retrospect, I realize weren't very well researched, but it's a big, new thing. He said I should hear back in 3-4 weeks from the insurance company.

3 weeks later, I called the insurance company as others have mentioned it's helpful to poke them a bit about it. Turns out Dr Lin hadn't submitted anything but the request and my photos, so there was no proof it was medically necessary. They'd reached out to his office for more documentation but hadn't heard back yet. I called, but didn't get a response or a call back. I had my chiropractor's office fax the records again, but it turned out my chiro had started his own practice and took all his records with him, so the original ones I had faxed were basically useless. I called his new practice and had them fax the records for real, this time. I called Dr Lin's office again, left a message explaining what was going on, and didn't hear back from them for another two months.

All that was mid-December. Right before Christmas, I received a rejection letter from my insurance. It was extremely disheartening, and the letter laid out all the requirements to be covered in very explicit language. I took the holiday season off to focus on other things and in early February, I started the process up again with the intention of getting 6 months of documentation, as required. I switched PCP's to be closer to work and because I wasn't crazy about my previous one.

On February 12, I saw my new PCP's PA and she was amazing! I told her I'd been pursuing a reduction for a little while now and she took a full history of my symptoms. She checked for range of motion, nerve damage, as well as a host of other things. She told me the health alliance my PCP was a part of actually had in-network plastic surgeons so she'd put me in touch with their referral specialist. The kicker? This was the EXACT SAME ALLIANCE my previous PCP was in! Crazy. Moral of the story: shop around until you get all the information.

The very next day, I received a call from April at Dr Lin's office (turns out the original administrator had left and so they seemed a bit disorganized) and I had gotten approved! I told her that I'd need to check with work before setting a date, so I'd give her a call back. They were only open Tuesdays and Fridays (this was a Friday), so I still had a few hours to get back to her before they closed. I called my insurance first thing and asked a ton of questions. I got the approval confirmed (turns out to see it in the web portal, you need to search for dates in the future) and the best news of all -- if I had the surgery before March 1, it would only be $150! My deductible is $500 so that's the max out of pocket I would have to pay anyhow, but $150!

Before hearing that, I'd been thinking about shopping around a little bit and waiting until April/May to have it done. I didn't like how hard it was to get in touch with Dr Lin, and the utter lack of customer service irked me. But with that deadline in mind, I decided I was fine with those drawbacks, as his work was still impressive.

I tried calling his office back for 2 hours but no one ever picked up. I finally left a message at 5 and resolved to try again when they opened on Tuesday. After a fretful weekend, Tuesday rolled around and I called them first thing in the morning. April let me know that the soonest Dr Lin could see me was March 5. Dangit. The pre-op appointment was going to be the week before with the nurse, but I insisted on setting an appointment with Dr Lin. I know many doctors are very hands-off, but I wasn't comfortable accepting it without pushing back a bit. I asked April to please let me know if there were any cancellations as I really needed to get it done before March 1 and she said she'd see what she could do.

In the meantime, I tried to call my insurance to see if I could get another approval expedited if I found a different surgeon, but their lines were busy/down. So I called another surgeon I liked and tried to see if he was available. Turns out he was, and the admin was very sympathetic to my plight, but they didn't accept my insurance. Dangit, again. That afternoon, after having resigned myself to getting it done in April/May and shopping around for a different surgeon again, April called me back saying there *was* a cancellation and I could get it done February 26!

Talk about a rollercoaster. I freaked out a bit, and made the appointment. My pre-op got moved to that Friday (yesterday) rather than the week after, and I again insisted it be with Dr Lin personally. I cleared the time off with work, and I was on my way! I'll put the pre-op details in another post, so this one doesn't get too long, but I'm finally getting it done!

Long story short for others looking to get this done: Shop around (surgeons, PCP's, everyone), because no one has all the information you need. You're the only one who is guaranteed to fight for your cause, so be sure to do the leg work yourself. It may sound cynical, but I've been in customer support my whole life and my husband used to work with doctors. They're just people at the daily grind (frequently with an ego), and everyone knows how rare it is for someone to actually go an extra mile for a stranger. They're out there, but it can take some effort to find them. :)

Next up: the pre-op!