fat grafting and insurance coverage

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meow1970
meow1970 Member Posts: 7
edited December 2016 in Breast Reconstruction

I had my first breast reconstruction surgery where I had expanders placed in May of this year and last week had them exchanged for implants. My PS has been discussing fat grafting. It never occurred to me that my insurance would not cover it. I thought that there was a law that said all surgeries connected with breast reconstruction had to be covered, but I have since learned that I am wrong. He said that my insurance company, the biggest one in the state where I live, considers fat grafting to be experimental and won't cover it, even though he said plastic surgeons had been doing it for years. He submitted it anyway to see if he could get pre-approval before this last surgery, but they denied it. When I saw him the next day after my surgery, he continued to talk about it and pointed out to me where we need to do it. He never asked me if I wanted to do it or if I could afford to. I commented that I wished my insurance would cover it and he said "good luck with that." Personally, I like the way my breasts look and will really like them when my nipple is reconstructed. They look better than the "originals" to me. Also, there are things about fat grafting that bother me. I have read that some researchers think that grafting fat into the breast could cause dormant breast cancer cells to become active. I think I read it here on this site. That really scares me. I have also heard that sometimes fat grafting won't take and has to be redone. Lastly, I don't want to pay out of pocket, particularly if there is a chance it won't take. I have not expressed these things to him because we really are not at that point yet. My PS is excellent and is known in my area as being the best. Breast reconstruction and augmentation is his area of specialty and he is a perfectionist. However, he does not have the greatest bedside manner. He is dry and to the point and does not smile a lot. I decided that I could live with that since I knew he was going to do a good job, and he has. I have a friend who used to work for him for 4 years before she moved to a different town. She sings his praises and told me that if she ever had to have plastic surgery done, she would definitely use him. She did warn me though about his bedside manner, though she said the 4 years she worked for his practice were the most rewarding of her life. However, I am not sure how he is going to respond when I do express all this to him. I don't find him to be the easiest person to talk to. I think it is going to be okay, but should it not go down well and I have to find a "second opinion", will the insurance cover a different surgeon finishing up something that was began with another surgeon? I have been really worried about all of this to the point that it has depressed me a little. If it "needs" to be done I want to have it done as long as it doesn't cause cancer, but shouldn't something that "needs" to be done be covered by insurance? Can someone comment on this with your thoughts? Thanks.

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  • Warrior4sararyan
    Warrior4sararyan Member Posts: 23
    edited December 2016

    Hi- I just had my exchange surgery and my PS said I will most likely need fat grafting. My breast surgeon had to be more aggressive on my cancerous breast. My PS tried to use a implant that would fill in the concave spot at the top of my breast. My surgery was only two weeks ago so we must wait and see how things settle and heal. My PS said that the insurance companies do balk at paying for it as they view it as cosmetic. He said he should be able to get them to cover it as it as way high on my chest and there is no way a implant could cover that. It is very noticeable and above my bra line. I will just have to wait and see and cross that bridge when I get there. Kind of like everything involving this journey we are on!!! My health insurance is BCBS. Lets hope they pay cause I have no more money after being off work dealing with BC.

  • meow1970
    meow1970 Member Posts: 7
    edited December 2016

    My insurance company is BCBS too.

  • flipflop
    flipflop Member Posts: 38
    edited December 2016

    Wow! That's terrible. Mine was covered no questions asked (Aetna). About 30% of fat injected takes, so he put in more than what was "needed" for that round. He said he doesn't do 100% round one because so little takes, so he does less each time but does three rounds. This give some time In between to see what took and let it settle. He said he has more success this way but you have to endure the surgery more times. So that's a downfall.

    An upside is the surgery was easy compared what all we've been through. A bit sore in my legs at the fat donor site but nothing more than a bad pulled muscle a few days.

    As for the dormant cells coming to life from grafting my PS said this was false and not found to be an increased risk of reoccurrence based on data... so I dunno when it comes to that. I needed it. I had tram flap surgery since I rejected expanders and had major divots and uneven spots and it added volume I needed as well.

    Had it not been covered by insurance, though, I may have just lived with what the result would have been without it. I don't think I could afford it.

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