Explant to Fat Graft NOLA Tricare

Heatherlgspa

Hello there!

I am a 10 year breast cancer survivor who had a bilateral mastectomy direct to implant. It is time to say adieu to the implants. Discomfort and aging of the implants has me ready to take the leap into a DIEP procedure.

I am seeing my PCM to request the consult to a plastic surgeon tomorrow. We are Tricare PRIME right now and I am wondering who has experience with surgeons in New Orleans? Also, when I was diagnosed, the original reconstruction was covered, so I am assuming that the DIEP will be as well.

Any advice and wisdom of someone who has walked a similar path would be so appreciated!

SpecialK

Congrats at being at 10 years! I am also Tricare Prime and have had some complications with implant reconstruction and skin healing that have spawned a significant number of surgeries - Tricare always covered them, so I am hopeful that you will have no problems. At the very least I assume the surgery would require a pre-auth, so that should be indicative of coverage. I have never had a surgery denied, or any imaging. My only Tricare Prime denials were for genomic testing at the time of diagnosis, and another at 5 years as Tricare ruled that those tests were "experimental" - but both labs ended up not charging me for the tests. I think it is important to note that you have discomfort, and this is prompting the change, that way it bolsters the decision to use a different means to reconstruct. I know that the Center for Restorative Breast Surgery in NOLA is mecca for DIEP surgery and they have been at the forefront of many of the newest techniques, and have tons of experience. I have implant recon but if I were to go the flap route that is where I would go, specifically because of their innovation, experience, and patient satisfaction. Your thread title says explant to fat graft, but that is not what DIEP is - rather it is removal of an abdominal flap of skin, fat and blood vessels that is similar to a tummy tuck with a hip to hip incision that is then moved to the chest. You need to be a candidate for this procedure also, so you would need to be evaluated to see if you meet the criteria - this involves having enough skin/abdominal fat, and also I believe there is assessment of the blood vessels as this is critical to survival of the flap. DIEP can often require staged surgeries to tweak aesthetics - which can include fat grafting, but possibly not necessary with a change from implants to an autologous method since the pockets already exist. Using fat grafting only to achieve reconstruction is a different surgery (usually more than one) so I just wanted to clarify for anyone else reading along. I have a friend locally who initially wanted DIEP and she did have a phone consult with the insurance specialist at the Center for Restorative Breast Surgery and they were very thorough and responsive to let her know what would be covered specific to her insurance, especially since she would have been traveling to get there. She ultimately went with implants and had surgery locally, but was very satisfied with her interaction with the people there in NOLA. Wishing you the best - there are some DIEP threads, and a specific thread about this location which can provide more details about the surgery itself.

Moderators

Hi Heatherlgspa, and welcome to Breastcancer.org! You'll find our community a very supportive and helpful place full of support and great advice. If it helps, we thought you may like to read up on our main site content about what to expect before and after the Diep Flap procedure, here: DIEP Flap

Hope this helps. Please let us know if we can provide any assistance navigating the forums or the main site. We are here for you!

Best,

The Mods