Breast reconstruction coverage after lumpectomy

sad-hubby

My beautiful wife was diagnosed with breast cancer ER+ & HER2+. She is currently undergoing neoadjuvant chemo TCHP (6 cycles) with Herceptin to continue for next one year. The treatment plan is: 6 cycles of chemo, followed by lumpectomy and radiation

She had two lumps in her left breast as well as lymph glands in arm pit area. Lumps have shrunk during the treatment. We are with Kaiser in Northern California. We would like to know few things before we meet the surgeon if anybody in this forum has similar experience

[1] Is the lumpectomy done by the breast surgeon or will the plastic surgeon will also be there?

[2] We know that in state of California breast reconstruction is covered for mastectomy. Is it covered for lumpectomy as well especially for Kaiser HMO.

Any input will be really appreciated.

Thanks

Trvler

I am sorry about your wife. I always find it so sweet to see husbands on here doing research for their wives.

Ok, I am fairly new here but don't reconstructions usually take place only after mastectomie(s)? If you are having a reconstruction at the same time, the PC would have to be there the same day.

SpecialK

Lumpectomies are usually done by general or oncological breast surgeons.  Generally, plastic surgeons are not involved.  Federal law (The Women's Health and Cancer Rights Act - WHCRA) covers reconstruction for mastectomy - and symmetry surgery - but does not extend coverage for correction of lumpectomy deformity.  Some states do have state sponsored legislation that includes reconstruction or symmetry regulations for lumpectomy, but there are not many of them, and from what I could tell California is not one of them.  Some insurance companies do cover correction of issues after lumpectomy, but it seems to depend on the individual situation.  I would encourage you to speak with a coordinator in the breast care center at Kaiser for more info.

sad-hubby

SpecialK & Trvler,

Thanks to both of you for the prompt replies. We did some additional research and found that there was a redefinition of the mastectomy in a senate bill in California (SB 255) The text says - " For purposes of health care coverage of mastectomy procedures, revises the definition of mastectomy to specify that the partial removal of a breast includes lumpectomy, which includes surgical removal of a tumor with clear margins...." [http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_02... and https://legiscan.com/CA/bill/SB255/2011]

We plan to check with our breast care coordinator also.

Moderators

Hi sad-hubby, and welcome to Breastcancer.org! We're sorry for you and for your wife... As you can already tell, this is a wonderfully knowledgeable, caring, and supportive community and we hope you'll find the information and support you're seeking here.

If you are interested, there is another topic under the For Caregivers, Family, Friends and Supporters forum called The Husbands Corner (for family, friends, boyfriends, ect.) where you may want to read or post also.

We hope this helps!

The Mods

Oncearunneralwaysarunner

Hi sad-hubby, sorry to hear about your wife's diganosis. While I can't answer your question regarding the insurance coverage for reconstruction with a lumpectomy as I'm in Canada with a different system, I'd like to share my experience with a lumpectomy.

I had a very similar treatment plan than the one that is in place for your wife. My chemo was a bit different. I had three tumours in my breast and at least one affected lymph node. I'm also triple positive so I also got Herceptin. Chemo first, then surgery (lumpectomy and Axilary Lymph Node Dissection). I too was concerned about the cosmetic outcome and I had good discussion about that with my surgeon. My surgeon was a general surgeon who focuses on breast surgery.

His responses to my questions were that a lumpectomy's goal was for a good cosmetic outcome, that given the overall size of my tumours a mastectomy might be recommended if chemo did not shrink them down enough. It's only after being mostly through chemo and seeing that my tumours were gone on the MRI that he fully agreed that a lumpectomy was possible. He also recommended waiting at least a year to let my breast tissue settle down and stabilize before meeting a plastic surgeon to discuss possible options. I took his recommendation and I am now 14 months out from surgery.

I don't plan on meeting with a plastic surgeon now. Maybe its due to the location of my tumours (6 o'clock position) but I'm happy with the results I obtained. Once I'm dressed, no one can tell that I've had a lumpectomy. I don't wear anything in my bra either. Yes, one side is a bit smaller and a bit higher than the other due to surgery and radiation but I don't find it noticeable enough to do anything about it now.

I'm sharing in the hope that it helps answer some of the questions you and your wife had while you wait to speak with your surgeon. I know that everyone's situation is different and that this is only my experience but I wanted to share.