Ask the Doctor- Will My Insurance Cover a Prophylactic Mastectomy If I’ve Had Gene Testing?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I did the gene testing in February; tested positive for BRCA 2. I want to go full steam ahead and be proactive with prophylactic mastectomy. I am 31-year-old single mom. However, in regards to insurance, I am in a pickle. I just switched jobs and will be obtaining new/different insurance with new company. Will the new insurance I am obtaining most be okay with the gene testing from prior company and proceed to pay for the mastectomy/reconstruction? I can provide all the results and positive test results as well to them to suffice.

Answer: Most insurances do pay for prophylactic mastectomies when you have a gene conferring increased risk. While I cannot tell you with certainty, the companies that offer the tests are pretty standardized, and there is no logical reason not to accept the results of a prior test. We would be happy to help you further define your options with your present insurance company, if you wish.

 Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can I have reconstruction at 70 years old?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: At 70 years and in good health apart from arthritis should I be concerned about an abdominal fat replacement breast reconstruction considering that the operation might be long?

Answer: We have successfully reconstructed a number of ladies aged 70 and older. Generally, they have done well, and age itself is not, strictly speaking, a reason not to have the procedure, if everything else is favorable. Having said that, there do seem to be more “bumps in the road” the older one gets. If you wish, we could call and discuss your particular situation in more detail.

Thanks for your question, and have a great weekend!

 Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can you help me schedule a consultation?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I am 35 years old, my BMI is 29. I have a pathogenic mutation of the ATM gene and strong family history of breast cancer (mom dx in 2016 at age 68 and also has the ATM mutation, two deceased maternal aunts dx in their late 30s). In January 2017 I underwent diagnostic mammogram and ultrasound, then MRI, and then an MRI-guided core needle biopsy of a 4.6×1.4 cm linear nonmass enhancement. Pathology revealed sclerosing adenosis, benign changes, and flat epithelial atypia.

Because of the atypia I am scheduled for an extensional biopsy on February 16, 2017, to remove more tissue and hopefully rule out cancer. I am trying to stay ahead of the curve and I am interested in pursuing what I hope will be a prophylactic mastectomy with immediate flap-type reconstruction, but understand planning and timing will depend on the outcome of the pathology from my next procedure.

I spoke with my doctor about prophylactic mastectomy and reconstruction (my doctor is a surgical oncologist and will be performing my upcoming extensional biopsy) and asked which plastic surgeon she recommended on their team for flap-type reconstruction. She told me that she would perform the mastectomy, that I would be flat for a while, and that the plastic surgeon she recommended would perform reconstruction during a second surgery at a later date because “that’s just how he does it.”

I heard about your center on a DIEP support group on Facebook, and your surgeons are so highly recommended and are in-network with my insurance. I have learned a lot about the procedures in the support group, and I would like a second opinion from your doctors as I know that immediate reconstruction is possible in a lot of situations. I live near Winston-Salem, North Carolina, and I am willing and able to travel to be in the hands of an experienced team. A Monday morning appointment for a consultation would be ideal because of the travel involved, and either location would be fine, but I am flexible. Can you please help me schedule a consultation? I feel uncomfortable asking my doctor/surgeon for a referral at this time.

Answer: Thanks for your question. I’m sorry you are having to go through this, but we will help you any way we can.

The only common reason to NOT do immediate flap reconstruction at the time of mastectomy is if we know or suspect that you will need post-operative radiation, because that can severely damage a new flap. The most common reasons for giving radiation are a cancerous tumor over 5 centimeters in size, or a positive axillary lymph node.

Hopefully, you will end up not having cancer at all, and neither of these situations will apply to you. We do immediate flap reconstruction very routinely, sometimes several times a week, and I suspect there is a very good chance you could have it done that way.

We work with several truly cutting-edge breast surgeons, and we would be happy to arrange for you to see both of us on the same day. If you wish, we will have one of our PA’s (Kim and Audrey) or Nurse Practitioner (Lindsey) contact you to get additional information, and help make arrangements.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Is reconstruction possible 14 years after radiation?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  In 2003, I was diagnosed with DCIS, had a lumpectomy and radiation on the right breast. Years later I have a large lump and had an MRI today. It probably is nothing but I am considering have that breast removed and having reconstruction done at the same time. Is this possible 14 years after radiation?

Answer: We routinely do successful natural tissue reconstruction on patients who have had previous breast surgery and radiation, and the fact that your radiation was 14 years ago will have no bearing on our chances of success. We would be happy to call and discuss your situation in more detail, if you wish, just let us know.

Have great day!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can you help me if I am without insurance and money?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I have no insurance and have no money and looking to get a mammogram I have not had a mammogram in four or five years and I am 64.

Answer: Our office is solely dedicated to the reconstruction process after mastectomy. For a screening mammogram you might contact Komen Lowcountry http://komenlowcountry.org/, and ask them about any community resources or financial aid you can investigate within your county of residence. This list is included on their website and includes information on the Best Chance Network among others. http://komenlowcountry.org/wp-content/uploads/2012/08/FA-TriCounty-Colleton.pdf. Hope you can find the help you need with this information.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can I have my silicone implants removed?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  Three years ago I had a double mastectomy after being diagnosed with breast cancer. Can I have my silicone implants removed? And what is the recovery time?

Answer: You can always choose to have your implants removed. If no further reconstruction is done, recovery time ranges from a few days to two weeks, possibly longer, depending on your individual situation.

If you have the implants removed and then have reconstruction with your own tissue, recovery is a lot longer, usually about two months.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can you have reconstruction after a full body lipo suction?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  Hello I’m a cancer survivor and I have a question. I’ve been on this roller coaster ride for the last past six years and I’m ready to get off of it six years with the painful mishaps of reconstruction NOT the cancer. So my question is…it possible to have breast reconstruction after you have had a full body lipo suction everywhere. I mean where would a doctor get any fat or tissue from? I’ve had several failed breast augmentation and several capsules therefore the skin is very thin.

I now have my 8th capsule (ROCK ) I’m just about ready to cut them OFF myself, totally miserable. I have just about given up my faith and search and doctors because every time I go under the knife and get my hopes up high. I end up in the same boat. Is safe to say I feel like cutting them off myself I’m sick off these rocks are very painful is there anything that can be done? Thanks in advance

Answer:  It may be possible to reconstruct your breasts with your own natural tissue, but I can’t give you odds without examining you, and then probably ordering an MRI angiogram to evaluate the status of the perforating blood vessels that we use to transfer tissue.

The first question is whether you have enough extra tissue left after liposuction to make it worthwhile doing a microvascular transfer to the breast area. The areas we commonly use are the abdomen, the buttocks, and the posterior thigh. “Enough” is a relative term, to a large extent defined by your personal breast size goals.

The second issue is whether you have usable blood vessels in any areas which we could potentially transfer as flaps. This can usually be determined by a pre-operative MRI angiogram. Unfortunately, this requires an unusually strong (3T) MRI machine, and a specialized exam protocol, so ordinarily it must be done at a special facility here in Charleston.

Thanks very much for your question. I would be happy to discuss your situation further by phone or in person, if you wish..

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can you you improve my issues and tell me the cost?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: Due to strong family history of breast cancer, I had a bi-lateral subcutaneous mastectomy. I had this surgery shortly after my husband died suddenly from a MI. I was in my early thirties with two young children to raise. I had such a poor result and complications from that procedure, I am now interested in using abdominal fat for both breasts. Until this year, I had no fat @ 123lbs.

I now have abdominal fat, @ 137lbs. The poor result of the surgery destroyed my self-confidence as a woman. I am 68 yrs. old in great health but, because of the way I look, I have never accepted an invitation for a “date,” in all those years. My chest is tight, painful, with random indentions that were cuts made into the muscle in an effort to give me some relief.

I got no relief, just exacerbated the look, the shape of both breasts. Does this sound like an issue you could improve? Also, could you give me just a ballpark cost, a guesstimate, the range of lowest to highest cost? Thank you.

Answer:  Good questions. I’m going to copy our doctors and physician assistant to answer the clinical questions for you. There are other options for you to consider and they can ask some questions to be able to help you decide what might work out best for you. The whole team is in surgery right now but I am sure they will reply as soon as they have a chance to catch up on their e-mail.

In the meantime, here are some basic ideas of cost. This would be for a “self pay” patient. We do accept most insurances so ultimately your financial responsibility would be based on the contract between you and your insurance company. This is a very rough estimate based on some research into the same question for a patient early last year. We’d have to update for you if you choose to proceed but it’s a good starting point.

The fee for a DIEP flap for a private pay patient is $10,000.00 per side. Rib cartilage resection to access vein $1604.78. Mesh placement to repair abdomen $1032.00. Second side/procedures are discounted by 50%.

Anesthesia is per hour at $500 for the first hour and then $300 each hour after. These procedures typically take 4 to 5 hours for one side.
Pre-operative imaging $3015.44 (MRA pelvis/abdomen)

East Cooper Hospital $ 25,000.00 – covers operating room and 4 day inpatient stay.

Hope this information is useful, please feel free to send any additional questions you may have, we’re always happy to help!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- Can you help with a radical?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: Had a radical on one side and a more common one on the other due to cancer. Can you help?

Answer:  If you have some extra skin and fat on your abdomen, buttocks, or thighs, then there may be a good chance we can use that to reconstruct you. It can be very difficult or even impossible to reconstruct a radical mastectomy defect with an implant, but if we are able to use your own tissue it could potentially be very straightforward, depending on the particulars of your situation.

I would be happy to call and discuss your situation in more detail, if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor- What exercises will help my pain?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had tissue expander insertion 3 weeks ago, drain removed today, filling started last week (60 ml) and again today. I’m having a significant amount of pain in my armpit, drain site and back of shoulder above scapula. Knowing I can’t raise arm above my shoulder, what exercises would help?

Answer: Not sure any exercises would help. It is fairly common to have pain in armpit and drain site, not so much so above scapula. My first recommendation is to discuss your concerns with your treating surgeon. We are happy to give you all the support we can, but at this point your treating surgeon should be your first resource. We are, however, here if you have further questions.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!