Cleavage

desny,

I'm wondering if, like the others have said, your surgeon left that extra tissue on purpose.  My onco surgeon had a reputation for being very skilled at skin-sparing mastectomies.  She also frequently worked with a reconstructive surgeon to do mast with immediate recon. It was clear from our discussions that she thought I was a good candidate for breast-conserving surgery (lumpectomy/rads).  When I said I wanted a mast, she seemed disappointed.  Then I said I didn't want recon, either.

So the last thing I said to her in pre-op before they wheeled me into the OR was to please leave me with a flat, smooth scar.  I did not want any extra tissue left there "just in case."  She understood.  My scar has no cleavage and no whorls--it's just a smooth, flat line from my breastbone to my armpit.

OTOH, yours can undoubtedly be fixed if you want it flatter.

 otter

Desny,  did the PS give you any idea of what's involved in the clean up - such as daystay or in the office, down time - etc?  I think i'll be in the same boat but i'm only 8 weeks out...so maybe it will get better in time.

Hi, Shirley,

You can win this, but unfortunately the insurance company can make you work for it. If you don't already have information packets from your insurance, call and ask them to send you complete info for filing both an appeal and a grievance. You'll need a calm and organized statement (outline form helps - you want it clear and easy to reference) stating the problem, the steps you've already taken, the exact action you want the insurance company to take, and all the reasons why they should do that. You also need as much supporting documentation as you can find: anything to do with reconstruction, skin-sparring techniques, usual ps protocol, etc. (assume they're as dumb as stumps and find information on EVERY aspect). Also include a copy of the complete 1998 Women's Health and Cancer Treatment Act (or whatever it's called) that provides for recon or other surgery. Highlight the crucial parts, but include the whole of each document. Also, attach letters from as many of your doctors/therapists/NPs/PAs as you can convince to support you. On your outline, note each document and letter where it's appropriate. THEN take the entire stack of papers, in order and neatly labeled, and HAVE YOUR DOCTOR FAX IT. If you fax or mail it they're not obliged to read the attachments, but if your doc faxes it they must read it all, every page. Good for them! They'll learn something! And one of the things they'll likely learn is not to mess with you again. Win-win!

Be sure to also file a grievance at the same time, stating exactly the anguish they are causing you with this delay and the impediment to adequate health care, recovery, and healing that they're causing. State that the action you wish to see is promp approval for the clean-up surgery they owe you.

I know this is a lot of work, but it's got its satisfying aspects. When I hand my doc's nurses a thick stack of documents to fax for me I always think they're going to balk, but they hate insurance companies at least as much as I do, and they rub their hands together in glee and chuckle as they retire to their fax machine.

Go get 'em!

Binney 

I had trouble with my insurance company as well, and I found 1) that there was an insurance ombudsman at my company who was willing to help me do the troubleshooting, and 2) that I just had to put one foot in front of the other in a mechanical and systematic way, and the insurance company capitulated. It took a long time and a lot of letters. But I ended up getting fully recompensed. You have to get into the mind-set that dealing with the insurance people is a job like any other, and you just take the steps and let them know you're not backing down. Good luck!

You are NOT oversensitive. While of course elimination of the cancer is the primary goal of breast surgeons, they should also be concerned with all the needs of their patients, which includes feeling as good as possible about the medical and cosmetic outcome of surgery. My surgeon is a highly respected doctor at a major medical center. Before surgery, I asked her to make the result of my bilaterals as "cosmetically pleasing" as possible. Even though I'd had prior lumpectomies on both sides, she managed to create thin, symmetrical incisions with no extra skin on my chest or under my arms. This made a big difference to me psychologically and in that sense aided my recovery. It sounds as if your surgeon was actually trying to give you a good result, but just not the result that you had in mind. If you bring it up in a nice way, hopefully he'll appreciate the feedback.

I'm depressed that your insurance won't cover the cosmetic repair. Hopefully, out-of-pocket won't be too expensive.

Barbara