Rippling After Skin Saving Bilateral Mastectomy with Immediate Reconstruction

Question

All done 16 years ago. I was very happy with my result. But now the implants are rippling badly and I have some "nerve"? pain on my chest which is relieved if I shift or move the implant. Will insurance cover another reconstruction surgery or is this a cost I would have to cover on my own?

Larry S. Nichter, MD, MS, FACS · Answer

Insurance will cover needed staged surgeries as a consequence of a mastectomy - past, present, and in the future.

	Here is the law:

	Women's Rights for Breast Reconstruction  Following Mastectomy

	The Federal Women's Health and Cancer Rights Act of 1998 is still the law today

	Under the federal Women's Health and Cancer Rights Act of 1998, a yearly notification
	of your benefits pertaining to breast reconstruction must be sent to you by your insurance company.
	The Women's Health Care Act states that benefits must be provided for:
	• Reconstruction of a surgically removed breast
	• Surgery and reconstrcution of the other breast to produce a symmetrical appearance
	• Prostheses and treatment for physical complications from all stages of a mastectomy, including lymphedema

	These benefits are subject to the conditions and terms of your plan, including maximum benefit amounts, deductibles,
	copayments, and coinsurance provisions. The benefits are subject to your plan's exclusions and limitations.

Richard Baxter, MD · Answer

First I have to say that skin-sparing mastectomy with immediate reconstruction is becoming quite common today but was not often done 16 years ago, so kudos to your surgical team and to you. One of the factors that has made it a more predictable procedure and a more popular one today is the use of Acellular Dermal Matrix grafts such as Alloderm, which helps to form an internal bra that adds support and coverage. Placement of Alloderm may be a good option to consider now. I would expect that your insurance would cover it.

Robert Whitfield, MD · Answer

You should be seen and examined to see what procedure would be appropriate.  Insurance authorization could then be obtained.Three basic forms of breast reconstruction exist. You can
use your own tissue, implants or a combination of the previous two techniques.
Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap
or fat grafting. Implants can be done in one stage or two stage. Two stage
reconstructions are started by placing expanders at the time of mastectomy.
Once they expanders are placed they are able to be inflated as determined by
wound healing. The final time consists of combining any of the above
techniques.

If you are interested in being seen in Austin please give
us a call.  I know this is a difficult time for you.  The majority of
my practice is devoted to reconstruction for women with breast cancer or who
are BRCA+

Fredrick A. Valauri, MD · Answer

The development of skin rippling following breast reconstruction with implants is likely due to scar capsule contractures around the breast implant.  Treatment for this problem includes exchange of the implant with release of the capsular contracture, with or without the used do AlloDerm to reinforce the skin flaps.

	 Alternatively,  while not for everyone, you may  benefit from the removal of the breast implant and breast reconstruction with your body's own skin and fat tissues.  These are specialized techniques that create natural, soft, warm breasts by transplanting the skin and fat from your lower abdomen, buttocks or inner thighs using microsurgery.  These procedures are known as perforators flaps and include the DIEP flap.

	See        nybreastreconstruction.com        for more information about these and other procedures.

Darryl J. Blinski, MD · Answer

Yes, insurance should and will cover most revision of reconstruction. As Dr Baxter states use of acellular dermal matrix (Alloderm or Strattice) can help. Also PRP fat transfers are another option. Finally in Europe Macrolane fillers could be a benefit . Regards.

Rippling After Skin Saving Bilateral Mastectomy with Immediate Reconstruction

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Rippling After Skin Saving Bilateral Mastectomy with Immediate Reconstruction

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