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Mar 5, 2010 12:51 PM, edited Mar 5, 2010 12:52 PM
Are you on a group health plan thorugh your employer? If so, if it's a larger company there may be a representative in the health and welfare department of your company that may be able to provide some guidance.
I wish you the best, I may be facing bilateral mastectomy and can only imagine your anger at this situation. I have doing a lot of research for reconstruction options and found a great resource at breastrestoration.org
Their section on implants says the following, don't know if this would be of benefit when formulating your appeal but it might help, the bolding was done by me.
"The simplest option for reconstruction is to have implants alone. This option is best for patients who have medical issues that prevent them from having a more complex surgery as well as patients who understand the limitation of this type of reconstruction but want to have a breast mound. This option is usually completed in two phases. The first surgery consists of placing a tissue expander in the breast area underneath the skin and chest muscle. The tissue expander, which can be expanded like a balloon, will be gradually filled by adding a salt-water solution approximately once every two weeks. Once your skin has stretched, in about three to four months, the next surgery will replace the tissue expander with a permanent saline or silicone implant. If you do not need the tissue expander, your surgery will only consist of inserting the implant. Although implant reconstruction is the simplest, it carries the highest incidence of complications
An implant reconstruction is not the same as a cosmetic breast augmentation procedure. In cosmetic breast augmentation, the breast implant is placed underneath normal breast tissue, which cushions the implant and therefore allows the breast to have a natural shape and feel.
After mastectomy, the breast skin is thin and due to the lack of breast tissue, the implant is readily felt. The implant is placed under the pectoralis muscle to improve the feel of the implant as well as to minimize infection and problems with scarring around the implant. The lower part of the implant will not be covered by muscle. Often, a collagen sheet is used to cover the lower part of the implant to improve the cushioning of tissue over this area. However, implants may become infected or the tissue around the implant may become scarred and firm in the future, and this needs to be taken into account when considering this option."
Diagnosis: 11/5/2009, IDC, 1cm, Stage IIa, Grade 2, 1/12 nodes, ER+/PR+, HER2-