Hello, all. Please bear with me on this long post...
Hello, all. Please bear with me on this long post as I am hoping to get anecdotes from those who have successfully obtained approval from Aetna for a breast reduction!
I have a consultation for breast reduction the first week of August and am anxiously awaiting the date. I am 32, 5'4, between 140-150 lbs, and a size 32F/G bra. My insurance plan is an Aetna POS II and I'm hoping that it will cover all or part of the procedure, as I'm not sure that I can afford the operation without it. I have read the Aetna plan guidelines and read extensive reviews on this site re: breast reduction and I am both hopeful and apprehensive about obtaining approval. My main worry is that, according to Aetna's chart, I would have to have 600g of breast tissue per breast removed and I just have no idea if that's even possible.
I have experienced similar symptoms as most on this site: neck pain, shoulder pain, upper and lower back pain, numbness in my hands when I lay on my side, difficulty in exercising due to shortness of breath and the buoyancy of my breasts (and I strap them down!), stinging/tingling pain between my neck and shoulders, terrible posture, and tension headaches, etc.
My other concern is that I have no documentation from physicians/physical therapy to corroborate my suffering. I complained about back pain due to my breasts to my PCP in 2013 but do not believe that she documented this complaint; instead, she handed me a card for a chiropractor. I did not follow up with this referral as I'm not comfortable with chiropractic treatment (professional/personal bias). Aside from this, I have tried massages (several years ago), I practice stretching and posture exercises, exercise regularly (including weight lifting exercises focusing on my back and abdominal muscles), have purchased a very expensive bed (approx. $2,500 tempurpedic mattress) and pillows, and wear very supportive and expensive bras (approx. $180-200 a piece) to no avail.
Has anyone had success in obtaining approval from Aetna WITHOUT extensive health provider records/documentation? Anyone have experience with the appeal process? Looking for real life personal stories about successes or failure, as I can hardly stand the wait!
Healing Progression (Surgery 12/16/16)
Hi all. I had my surgery on 12/16/16 and so far it's been a rollercoaster of emotions and experiences. I wanted to track my progress throughout the healing process, so I thought I would begin by uploading some photos. Apologies for the poor quality of the pre-surgery photos, but they give one a general idea of what I was working with. I also look forward to interacting with other members, as I have so many questions and insecurities with this entire ordeal.
Height - 5'4
Weight - 145
Bra - 32F
The first five days were truly very difficult for me! I left the hospital in great pain - which the nurses were reticent to address - and the next two days alternated between a drugged sleep (thanks Percocet!) and horrible pain. Day 2 was probably the worst - I had a migraine that lasted a day and a half and it made me weak, nauseated, and unable to sleep. I got the chills and became too weak to sit up and take my pain pills, which I desperately needed! I cannot stress how important it is to have support around you! Thank goodness for my husband, who woke me up every four hours to administer my various medications, force me to eat a little soemthing, help me to the bathroom, etc. Day 3 was easier (finally had a bowel movement!) and I was able to get up and move around on my own. I switched to extra strength Tylenol and the only real discomfit was a burning sensation (nerve regeneration - a good thing!) and itchiness! I spent the majority of the first five days in bed and have no regrets about it. As for food, I mostly ate a puréed asparagus soup, green juice, and crackers, all of which sat well with my stomach. The attached pictures are from the day of my first follow up. My doctor said I was healing well (you look like you're three weeks out!) and told me that I could pretty much return to all of my normal activities, even running if I wanted! He advised that I should let my level of comfort dictate how active I am and the only real restrictions I was given were a) no shower hitting directly on the incisions; b) no swimming or immersing myself in bodies of water.
Day 5 photos
Taken after my first doctor follow up
After the first week, I pretty much resumed my normal life with little discomfort. Overall, the major pain occurred at night in the form of burning sensation and general restlessness that prevented me from a good night's sleep. I began showering every day by myself, wearing over that top shirts, went out shopping, had some alcoholic drinks, cooked Christmas dinner, even reached for things in high places. My doctor told me to be as active as I could be and to move my arms, so active I was. I took 1/2 hour walks and even did my first driving. Overall I felt ok and stopped taking Tylenol towards the end of the week. My breasts were definitely sore, but nothing too bad. I did, however, begin to feel super emotional and could erupt into crying at the drop of a pin. Whether it was being frustrated at how slow this healing process will be, the burning at night, and now worrying that my breasts were becoming too large. So much uncertainty and constantly wondering whether my healing was coming along correctly. Like I mentioned, my doctor pretty much allowed me to go back to regular life after day 5 and it left me unsure of whether I was overdoing it (I've never read of anyone having these instructions!). I had no bleeding or discharge at all and my incisions hadn't opened. Still, it's a scary process and not knowing how everything is going is perhaps the hardest part of all.
Day 17 photos
So, 2 and a half weeks out and my breasts have already changed dramatically. They seem bigger, which is making me sad, but my doctor told me not to be too invested in the shape or size yet, as they have a lot of settling to do -- despite my relative inactivity, they're not getting fat! There still may be swelling, but again, my doctor (who I saw the day after these photos) is pleased with the progress and told me I could return to taking normal showers now (using a wash cloth to begin rubbing away the remaining glue ) and could even sleep on my side. He told me I could wear any undergarment I would like without an underwire (including just camisoles) - or nothing at all, if I so desired (though he says over time this will likely lead to premature sagging) - and again reiterated that I was fully cleared to return to any workout I want - aside from swimming. Also assured me the puckering will smooth out and my nipples will hopefully lose some of the oversensitivity. Yay! I returned to work today (desk job) and had no pain until midday, when my nipples and sides began to burn. I took two extra strength Tylenol which helped slightly but I think it's just going to have to improve over time. Hour drive each way with no pain or discomfort. Pleased with my progress so far!
Day 5 v Day 17 comparison
A look at how my beasts have already changed in just under two weeks. Day 5 photos on the left, Day 17 on the right.
Nothing new to report this week - was back to work with little issue (burning sensations towards the end of the day, but manageable) and I am happy to report that I suffered from no back or neck pain during the day (usually I would be in agony by noon!). Breasts continue to settle (the puckering/folds are beginning to go away) and I have been encouraged to start removing the glue which are over the stitches as it comes loose from my skin. I have not started scar therapy and wonder when my doctor may recommend it, but first all of the glue needs to come off. Overall, I'm happy and everything seems to be on the right track!
One month down! Into week five...
I can't believe a month hasn't passed since my surgery date. The first week seemed endless in that I seemed to be in a general state of slight pain at all times and the second week really started to wear on my patience, as I felt a general stage of discomfort at most times. Week three was a return to work (easy, but sore towards the end of the day) and this week has been pretty much the same, with the soreness towards the end of the day pretty non-existent. I exercised this week (finally!) and felt perfectly fine (just rode the bike at a good intensity for half hour) and will probably try running this week. The glue is nearly all gone from my incisions and this week they look red and are super itchy! Still haven't started any scar therapy, but I plan on researching that this week and starting soon. It looks like I might have some scar revision necessary (the folds of skin where my cleavage will be --- is that a dog ear? Whatever it is, it can't stay) but I'm still over the moon with everything. I feel so much slimmer and completely without upper back, neck, and shoulders pain, which makes this entire experience SO SO SO worth it. I am really happy and just have nothing negative to say at the moment.... love everything! For my own records: still sleeping on back and taking showers with the jets hitting my back, but working up my courage to finally turn on my side/turn around, respectively.
Over 6 weeks out
Time flies! Just a quick photo update, even though the quality is terrible. The incisions along my side are itching like hell and I have noticed a rash of small red bumps near the itchy area. My nipples are also constantly itching - torture! The remnants of the glue seem to be finally wearing away and a few small stitches may be poking through (I think!). I applied bio oil to the scars tonight and also cortisone to the itchy areas. Follow-up with my doctor is about two weeks out and I'm excited to hear what he thinks and the plan for the long term. Finally, scars are bright pink and the inner bits near the cleavage still like little nubs (boo). Running and exercising like normal with little discomfort.