Charleston Bound, part 2

Dr Massey was out of network for me. I have Blue Cross/Blue Shield. They said I could go out of network if there was no surgeon within 30 miles of me. So I researched and found out there were none. I filled out paperwork requesting an in network exception. Then sent the paperwork to Dr. Massey's office. She filled in the surgical codes and mailed the paperwork in to BCBS. It was approved within 2 weeks. She was paid in network rates. The in network exception included the assisting surgeon, Roper Hospital, all scans, pathology, anesthesia, etc. It was a lot of phone calls and record gathering, but I did it during the 8 months of chemo and rads. The only thing I had tp pay for my Stage 1 was $200 for private room charges.

PinkHeart, I'd be interested in knowing what your progress is with the Brava. How/where do you buy one and how much are they? Dr. Kline mentioned that I might want to consider the Brava...If you buy one from Dr. Kline, do you also have to have fatgrafting from him? My local PS can do fat grafting but not Brava coaching, since it's not covered by insurance. If I may ask, are you using Brava to fill in space around your SGAP flaps or to get bigger in general? Also, I've heard that flap surgery is beneficial to people who have had radiation because it is a healthy flap feeding the surrounding radiated tissue. Can you share your experience about having a flap in radiated tissues? I wonder if you can tell if they are doing good things for your tissues. Thanks.

Does anyone know if Dr. K does Juvaderm? I want it done for a wedding and I might as well get it while I'm on painkillers!

Marty,

That is an old web site from over a dozen years ago when Dr. K & Dr. C first went into private practice. Here is the correct link:

http://www.naturalbreastreconstruction.com/

lbrewer,

Your best bet would be to call. I saw some brochures for skin rejuv when I was there. I sure could use some rejuv myself.

rdgc,

The price of BRAVA device is ~$800. If you want to get through the treatment faster, instead of using the little hand pump that comes with it a "turbo" device (wound vac) can be used. This can only be purchased and ordered by a physician. It is several thousand dollars. Dr. Kline is having me use this for my specialized treatment with no charge. He and Dr. Craigie went through a brief training in Miami with surgeon who pioneered Brava.

The BRAVA phone number is 800-407-5304 and website is www.brava.com You could also network with other Brava patients at www.fatgraftpatients.com

I had bilateral SGAP because I am very thin.

I had implant failure from SEVERE damage from radiation as well as axillary cording caused by removal of 19 lymph nodes. The cording attached in side of chest wall and runs through axilla up to my elbow. I had a dozen of them at one time. Also had lymphedema in upper right quadrant and right arm. A lot of these major issues have been resolved thanks to expert skills and compassion of Dr. Kline and my physical/lymphedema therapist. My PT-CLT therapist was able to release the dozen or so cords except for the evil mother cord. A doctor at Johns Hopkins made it worse and more cords grew down to my wrist. Dr. Kline took a different approach in surgery on it and I gained much more range of motion, however I do still have mild pain from the evil thing depending of physical movement.

Dr. Kline also did a lymph node transfer nine months ago, and I have not had any lymphedema swelling since!

Dr. Kline spent 3-4 hours doing major repair work from rads damage before he moved on to performing the SGAP flap transplant. So my first stage surgery ended up being 12 hours. He repaired pec muscles, meticulously removed TONS of scar tissue, Alloderm that was used for implants that failed/bunched up and got fried to my chest wall during rads, and has done fat grafting to the damaged area to help with healing.

The SGAP flaps also provided an amount of healing to my damaged area, but Dr. Kline ordered 30 days of HBOT-hyperbaric oxygen therapy treatment where I had to lay in a chamber/cylinder every day for 90 minutes (with drains still in, and a still tender SGAP butt!).

Fat grafting is being done for symmetry and for healing in radiated breast. I have very little fat to spare, so instead of traditional fat grafting, he is trying the BRAVA with me since it is known to increase survival of grafted fat. Also, the BRAVA promotes more blood flow to the breasts/chest area which should also help in tissue healing.

I will be about a B cup when done. My failed implants were a C to small D.

I know a woman who was a AA and had bilateral mastectomy. They put in tiny implants during surgery with no need for TEs. She did not have radiation. She is going to have revision surgery but I'm not sure why.

There is one plastic surgeon in my city who is doing fat grafting with BRAVA and part of the study. However, he ONLY does it for cosmetic breast augmentation patients and accepts no insurance.

Dr. Greenburg in San Francisco is very involved with BRAVA. She has an excellent blog. You may want to check her out.

Hope this wasn't TMI.

What is your diagnosis? Did you have lymph nodes removed? Nipple sparing mastectomy?

With your desire to remain an A/AA cup and if you have little or no rads damage, I personally would go the BRAVA route. It's still quite a commitment and you will have multiple surgeries. But, you won't have anymore "cutting and sewing."

I only have enough fat to have one period of wearing BRAVA device followed by fat grafting surgery. It will be my 10th surgery (and last) since being diagnosed in June 2011.

Please feel free to PM me, and much luck to you in your personal decision.

Rdgc,

I am fortunate to have insurance that covers everything. Only $1,700 deductible/out of pocket per year and zero co-pays, and can go anywhere I want (except of course not to PSs that don't take any insurance in first place). No way could I have paid $35,000 for HBOT. Dr. Kline is one of few top microsurgeons that accepts all insurance.

Please know that Dr Kline is 100% devoted in his pratice to flap surgeries and breast cancer patients only.

Like Dr D, he does extensive lipo/fat grafting for Stage two surgeries to give symmetry and shape. So Dr D does lots and lots of fat grafting but just to give shape and symmetry to his flaps.

Since you are only needing one breast, and a tiny one at that, that will probably be the first time for Dr K to suggest that, as far as I know. He is def pro-flap.

Have you consulted with Dr Khouri?

Hello my Charleston friends! I think I am finally over my superstition enough to give you guys an update :-)

2 weeks ago today, I had a left side PAP flap with Dr. Craige and Dr. Allen assisting - talk about the dream team for surgery! My flap is still surviving, and I am taking things one day at a time. For you newbies, this is my third left side flap attempt. First was SGAP in January, second was stacked DIEP in March. Left side was my cancer, radiated side. I also had my right side done prophelactically with my SGAP. I have had absolutely no problems with my right side. This time, I stayed in the hospital for the week (6 days total) after surgery, and spent another week at a rental house that was about a half a block off the beach on IOP. Dr. Craige and Kim (the PA) were awesome as always, and we have all been super cautious this time with my high risk history. I have also done HBOT before this PAP flap, to help with my radiated tissue damage. I also spent an in person visit with Dr. Khouri this summer discussing BRAVA when deciding what I was going to do next. I decided to give another flap a try, and use the BRAVA as my last resort. I can answer some BRAVA questions if anyone has any. I can also give advice on the differences/experiences with the different types of flaps now that I have experienced the SGAP, DIEP, and PAP, lol. I don't believe the NOLA doctors are doing PAP flaps that much yet. Dr. Craige and Dr. Kline have been in network for my insurance, the NOLA docs were not. Also, Dr. Massey told me she was out of network when she is performing surgery in NOLA (all stage 1's now). That was this time last year, her status may have changed in NOLA since then. I started out talking to Dr. Massey and eventually went in another direction because of the insurance issues. I know a lot of NOLA ladies take that leap of faith that the insurance will all work out, however that is just not in my nature.

In my opinion, the PAP has been the most tolerable pain wise, except for sitting on the toilet (sorry if that is TMI). For my friends who have been following my previous heartaches, I think we can all breathe a collective WHEW! I have missed being on the boards more lately, but I have been super busy trying to get everything scheduled and was really superstitious this time. I told very few people that I was going this time, just didn't want to jinx anything. If anyone has specific questions, feel free to PM me or post here. Talk to you ladies soon!

Beth

Beth, I am so happy for you too! What a blessing. Your positive attitude is an inspiration to all. Wishing you a easy recovery.

welcome to the land if happy PAP! The toilet problems will soon be over, I found leaning to one side or using the "go girl "ladies urinal from Amazon worked best - tried it outin shower first - but it will pass. I'm 10 months out from my PAP and find I forget that I've had it more than I ever did with the SGAP. Continued best wishes and prayers for healing and outcome!! Dr Allen works so well with Dr K and Dr C - I love their continued relationship beyond mentor / mentee!

Beth I too hope we all have the first of many reunions in Charleston next fall!!!

So glad you shared with us!!!! Woohoo

Hugs

Catie

hooray for you Beth!!! third time is a charm!

Has anyone had a hysterectomy in Charleston while doing a stage 2? Find out tomorrow if I will be needing to have the rest of my girlie stuff taken out and Dr M has recommended Dr Terry in Charleston if I decide to combine the 2 surgeries.

Maggie

Catie,

Our surgeries are same day. What days will you be in Charleston?

A friend has offered me a plane ticket so now I can't decide whether to drive or not. I like having my car to come and go and not have to rely on my friend and not being tied to plane schedule.

Who is first in OR?

Dr K said I would be about three hours.

I think that paperwork is standard. Dr. M is my doctor and I trust her totally. She is one of the only doctors that doesn't give free access to her before/after photos online - you need a password from her office. She is very sensitive to privacy and you could explain to her why you believe you would be easily recognized. I have seen her presentations and those of other docs - I have seen photos of friends and didn't even realize it. Consult with her, share your concerns. She is a wonderful, caring, compassionate and highly skilled micro surgeon - she will listen. You can't go wrong with Dr. M!

philomene, I also completely agree with Marty and Cherrie. She'll take wonderful care of you.

I have never had to fill out a massive amount of paperwork for a recon consult and I have had several,both in person and by phone.I had a phone consult with Dr.Massey,I sent her photos,there was no paperwork required,so this must be something new.I was not asked for anything like this from Dr.Kline for my phone consult other than pictures.Of all the doctors I sent photos to,Dr.Kline was the most sensitive and seemed to understand how hard it is to put it all out there on the internet,so to speak.

Yea! Beth! I've followed and read about your previous attempts. So glad you kept this flap!!

I've thought about asking Dr K to do an eye lift while I was under this next time. Hopefully, I'll be through after this.

As far as the photos go, I'd expect any doctor to be trustworthy with the pics. At this point with the surgeries, LE treatment, tests, etc....I'm not the least bit apprehensive as to who sees what!! In fact, I'm kinda proud they look this good and we're not finished yet!!