Odds of getting prophylactic a year or two down the road

LaughingGull, do you know why it was not done in one surgery? My surgeon suggested the same, first affected breast, and then the other one. I am not sure why. I am going to ask when I see him again but wanted to know what were the reasons in your case.

I went for a prophylactic mastectomy about a year and a half after my UMX. I had a BIRADS 4c on my first mammogram after treatment. The wait for the biopsy felt horrendous to me. My breast surgeon completely supported my decision and insurance was not a problem. I then had to have another biopsy just before surgery so I knew I had made the right decision for me. I do have somewhat better symmetry also

bookpusher - are you having reconstruction? If not, bi-lateral surgery is pretty well tolerated. I would want to be very sure that Medicare will cover a truly prophylactic surgery before deciding to forego having it all done at one time with the hope of doing another surgery later. It is important to also consider that you could develop a co-morbidity in the interim that makes additional surgery inadvisable or more risky as well, thus removing or complicating that option. Generally, Medicare will cover mastectomy based on "medical need" but I would press your surgeons on how they would code the second mastectomy if there is not actual "medical need" and if they have had success getting Medicare to cover a truly prophy surgery.

Thank you LaughingGull. So different circumstances. My own tumors were missed by ultrasound 2 months before I found one of them so my decision from the beginning has been BMX

bookpusher - if you are strongly considering bi-lateral surgery, I would personally do it in one go now if you feel you are otherwise healthy enough to undergo it. Without reconstruction it is definitely not as long a procedure. Are you in a position to have family support or help when you come home? Otherwise, you need to be prepared for the possibility of being unable to have another surgery later - either because a surgeon will not remove a "healthy" breast, or Medicare will not approve it. I have seen a number of people on this site who have had unilateral mastectomy when they wanted bi-lateral, and have been unhappy about it. I spent about 18 months with one reconstructed D cup side and one flat side - not the same situation as a native breast and a uni mastectomy - but it presented challenges with clothing and I did feel significantly unbalanced, as I am petite. I was much happier when that was rectified, but that is just my individual situation. Has your surgeon indicated what specifically he/she is worried about in regards to doing a bi-lateral? Also, wanted to note that I have read your other posts about lumpectomy versus mastectomy, and wanted to let you know that I was initially offered a lumpectomy. I had some time to consider options because my surgeon was attending a conference and I needed to line up a consult with a plastic surgeon. I ended up opting for a bi-lateral mastectomy because I had 20 years of issues and felt that if I could make cancer in one breast, I could do it in the other - so I wanted both off. My surgeon was totally cooperative and supported my wishes. Turned out to be the right choice - 2.6 cm of IDC plus a lot of DCIS in the right side that was also node positive - not discovered until surgery - and the "prophylactic" side was full of ADH and ALH - a ticking time bomb.