Removal of both breast

mjhawk43 · Guest

I was diagnosed on Sept 14th. Had a lumpectomy on Sept 30th and did not get clear margins. I'm scheduled to have the left breast removed Nov. 3. I dont want this to happen to me again, so I'm highly considering having the right breast removed on the 3rd also.
What do you think?
My doc. thinks that it is a bit drastic because there has not been a detection of cancer in it yet.
My thinking: Living life with my wonderful husband, my 4 yr old and 7 yr old
No more mamograms, biopsies, lumpectomies and sleepless nights waiting for the reports to come back.
Question #2
Does insurance cover the removal and reconstruction of a healthy breast when cancer has been detected in only one breast?
I cant get into see my plastic surgeon until March 14. She has come highly recommended and I have decided to wait for her.
I spend a great deal of time in my swimsuit and want to have as much symmetry as possible.
Thank you for your help in answering some very difficult questions.

NGibbs1028 · Guest

Hi,
You didn't say what stage you were or any details, so I'll tell you about me. I had just turned 43 when I was dx with Stage IIIA Invasive Lobular BC on Valentine's Day of 2002. I had a 5.5 cm tumor and 9+nodes positive out of 16. I opted for a mastectomy. A year later after chemo, rads etc. I opted to have the other breast removed. I was considered high risk because of my age and the stage. Lobular also is more likely then ductal to mirror itself in the other breast. I wanted to do everything possible to prevent this beast from coming back, just like you are talking about doing.
My surgeon wrote a letter to the insurance company because I have to have preapproval for "elective" surgery. My surgeon didn't go into alot of details in his letter. He told them my dx and my desire to have the other breast removed and that HE thought it was a reasonable request. Insurance approved it.
As to your other question, yes, insurance has to pay for reconstruction even on a healthy breast that is removed. I tried bi lateral reconstruction with horrible complications, so now I'm boobless, but I'm alive Smile

I hope this helped some
Please keep me posted
Nancy

attababy · Guest

It really isn't drastic at all to have the other breast removed. There is a rate of recurrence for cancer in the other breast that is based on your current cancer. If you are younger your breasts are more dense, and finding cancer on a mammogram is more difficult. So, even if you were lucky to find it early this time, you may not be as lucky the next time (if it does come back).

It is easier to create symmetry after bilateral mastectomies. But you should explore your reconstruction options well to be sure you make the right decision for you.

I had bilaterals with immediate expander reconstruction. My initial surgery was very painful and I needed quite a bit of help for a while. But others have not had as much pain, and this may vary by body type. I'll be having my exchange surgery soon, and so far things look good.

Good luck!

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Hi

Screening for breast cancer in the remaining breast after a mastectomy is always a must. Having a personal history of breast cancer increases your risk of having breast cancer in the remaining breast. It seems obvious, but there are studies that have shown it.

Despite not knowing much about your history, there are so many things that should be taken into consideration when making a decision about a mastectomy. Like Nancy, lobular carcinoma is one that is frequently multi-focal. You should estimate your breast cancer risk using the Gail model or the NSABP calculator. The number given will underestimate your risk, because you already have a personal history of breast cancer. Better yet, you should explore with your physician your reasons for you wanting a mastectomy, and his role is to show you the right direction, that's what we doctors do. There is so much junk on the internet that I find it very difficult to find a truly independent analysis of something for non-medical people.

yours sincerely
Leo
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Disclaimer: this information is for informational purposes only. It is not medical advice.

richmondnan · Guest

I had a bilat mastectomy 4/30/04 together w/ insertion of tissue expanders. I only had a relatively small Infiltrating Ductal Carcinoma (1.2 cm) in one breast. I had similar outlook to your own about removing both and "getting it over with". However, this is a very individual decision, of course.

I have been fairly lucky as pain was not bad. I did find that one of the pain meds was much more effective for me than the other one, so ask your dr about alternatives. I really don't like meds much so I got off of them as soon as I could. In my case, I was back at the gym in 10 days, taking 3/4 mi. walks on Tues after Fri surgery. This too is highly individual, but just so you know you don't necessarily become immobile.

As I understand it, after a significant march in '97-'98 legislation was passed which assures that those who undergo mastectomies can get reconstruction without it being considered "elective". I had no questions from my insurance co (which is frankly a pain in many ways) about the choice of bilateral mastectomy.

Finally, I too had to wait a bit for my selected plastic surgeon (just several weeks, my surgery was 6 weeks after my biopsy). I am very glad that I waited as she is marvelous and I feel very comfortable w/ her. You will spend a lot of time w/ the plastic surgeon if you undergo reconstruction and imho, it makes it much easier if you are totally confident w/ your choice and able to discuss your preferences clearly.
Good luck!
Nan

annie · Guest

Hi my name is Annie. I just registered on this site [that's not working so well right now] I found this url for this site on another bc support group. [alt.discuss group] I was dx in 4/1999 and again in 2002. Recurrance, MRM, followed by 6 months of chemo[4AC/4Taxotere]

I was replying to a post by "Nan" who mentioned a law that requires insurance companies to pay for reconstruction of the mastectomy breast, as well as the remaining breast [as in "sysmmetry"]
It's legislation that was signed on October 21, 1998 by then President Clinton. It's called "The Women's Health And Cancer Rights Act" Or "WHCRA" for short for a net search. I hope this helps. I'm now in the middle od a dispute myself with my HMO because I want to have the other breast removed due to stress of having this twice, and would prefer not to have to got through this a 3rd time. Every one of my doctors agrees with me. The one and ONLY hold up is my HMO.
I'm making another run at it shortly. It's been almost 2 years since my last request. I'm hoping the approval process has "changed hands" I'm hoping the "medical director" has moved on...
Take care everyone
God bless
annie

MuttsMom · Guest

For those of you that had expanders/implants, did you have radiation? I had a MRM when dx on Valentine's Day of 2002. I had a SM in May with bilateral reconstruction. I did the expanders but the skin wouldn't stretch and the pain was horrible. The PS went in about 3 months later to remove scar tissue from the radiation and had to remove the expanders. My skin wouldn't stretch and the expander was literally trying to come back out of my skin around the sternum area. I was just wondering if it was just my bad luck, or if either of you had radiation and everything is going fine with just expanders.
My skin is SO tight on that side, that the x-ray Monday showed I had 3 healing ribs. I can't help but believe that it's the pressue from the skin glued to my ribs and no elasticity.
THanks
Nancy

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