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All TopicsForum: High Risk for Breast Cancer → Topic: cost of prophylactic mastectomy

Topic: cost of prophylactic mastectomy

Forum: High Risk for Breast Cancer — Due to family history, genetics, or other factors.

Posted on: Oct 23, 2007 04:28PM, edited Oct 23, 2007 04:28PM by balletgirl

balletgirl wrote:

Hi, I'm new here.  I was wondering if anyone here knows how much it would cost to have a bilateral prophylactic mastectomy?  I don't have insurance, so would need to pay for the procedure myself.  Thank-you.

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Oct 23, 2007 05:20PM Nan72 wrote:

Hi , I would check with the hospital where you are going to have the procedure they should have a listing of their prices, let them know you will be paying for the surgery yourself they sometimes give a discount in those cases.  Good Luck , my prayers are with you for a speedy recovery.

Nan

Remember it's not how many breaths you take but how many moments take your breath away

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Oct 24, 2007 08:33AM, edited Oct 24, 2007 10:46AM by leaf

I don't know the cost either, but I'll be interested in further posts. But just wanted to share my experience as a self-pay person when I went for a consult at a major institution. They can change charges afterwards. I paid by check for the consult, then a month later got an additional bill for 15% more.

Are package deals possible if you pre-pay? A while ago, I was interested in a different elective surgery (not breast). From the online support forum, it sounded like some hospitals would also give you an additional discount if you *pre-paid* the cost. Maybe some places can give you a package deal if you pre-pay?? I'm not sure what they do if you have complications.

Self-pay patients usually pay a lot more. I just had an unrelated surgery in July, and for one item, they billed $40K to insurance, and insurance paid $4.5K. It sounds like they were charging private patients 10 times more than insurance patients for this item.

If you're going through hell, keep going-Winston Churchill

Dx 12/8/2005, LCIS, Stage 0, ER+/PR-Hormonal Therapy 07/15/2006 Tamoxifen
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Oct 24, 2007 09:43AM marshakb wrote:

Balletgirl,

I had a prophylatic mast on Oct 1.  I have no insurance.  I  just got the bill from the hospital and it is $14,000.  This does not include the surgeon's bill.  I chose to do a drive thru mast, surgery at 1 pm and out of the hospital at 7 pm to save on the cost of a night in the hospital. 

My surgeon wrote the order as "a matter of life or limb" since my original dx was ILC (right mast in Dec 06).  This way the hospital coould not refuse to do it.  I didn't even question the cost before hand because I didn't want to be overwhelmed by the amount.  The most important thing to me was to get that ticking time bomb off my chest.  Even after, I am trying not to be upset as the bills roll in, I'll just pay what I can as I go.

Best of luck to you.  Where are you located?  Someone might can give you local advice.  Marsha

I'm not dead yet!

Dx ILC, Stage IV, 1/13 nodes, ER+/PR+, HER2-
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Oct 24, 2007 12:34PM, edited Oct 24, 2007 12:45PM by balletgirl

Thank-you Nan, leaf & Marsha. 

Marsha, when you say your bill was $14000, but didn't include the surgeon's bill, what do you mean?  I'm located in England.

Hope you're recovering well from your surgery.

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Oct 24, 2007 03:29PM marshakb wrote:

Balletgairl,

The $14,000 is just for the hospital.  From admitting to pre-op, the operating room, recover room, etc., gauze pads, whatever the hospital used, this was the bill.  It was itemized to show each charge. 

The surgeons office will send me a separate bill for his actual services of performing the operation.  Whatever he charges for an hour and 1/2 of his time. 

Thanks I am still a little sore but healing nicely.  Marsha

I'm not dead yet!

Dx ILC, Stage IV, 1/13 nodes, ER+/PR+, HER2-
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Oct 25, 2007 03:14PM balletgirl wrote:

Thanks for your reply Marsha.

Glad you're healing well.  Hugs.

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Oct 25, 2007 03:37PM angelaw wrote:

Hi: had bilateral in july and final implants yesterday.  I know full amount at Northwestern Hospital, chicago was approx 100,000.  Then they discounted it with the insurance co and the real total was closer to 40k.  Northwestern had a sign in the waiting room telling people that they had donation funds for use.  Good luck.

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Oct 25, 2007 09:08PM, edited Mar 1, 2008 12:38PM by balletgirl

This Post was deleted by balletgirl.
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Oct 25, 2007 09:08PM, edited Oct 25, 2007 09:12PM by balletgirl

Hello angelaw,

I was wondering if the $100000 included your reconstruction?  Hope you're feeling well.  Hugs.

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Oct 26, 2007 09:18AM Sandra1957 wrote:

I'm part of an HMO, but had my bilateral at a contracted hospital almost two years ago.  The hospital sent me a bill for around $27,000 for surgery and overnight hospital costs and $1600 for pathology.  This did not include surgeon, anesthesia, pre and post appointments and testing, ON-Q pain pump, medications, camisoles, or reconstruction costs (I had delayed reconstruction).  I would say that $100,000 would be a close estimate.

Good luck to you. 

lini

I'm always steppin' in and out of crap!

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Oct 26, 2007 10:31AM balletgirl wrote:

Thanks lini,

I am interested in your comment. If I have this operation done, I would not have a reconstruction as this seems to increase the cost hugely.  Am I correct in saying that the difference between your initial $27000 bill, and final $100000 bill is mainly the cost of recon?  Thanks for your help.

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Oct 26, 2007 12:33PM Sandra1957 wrote:

My guess would be, yes.  I have a friend that does mastectomies and referrals to PS for reconstructions.  He says that he has many younger patients that forego reconstructions even with insurance because they can't afford the 20% deductibles which can be as high as $40,000.  Also, remember that $27,000 was only hospital fees.  I don't know how much the breast and plastic surgeons, anesthesiologists, and a second hospital stay would cost for sure.  Not to mention expander, implant, saline, etc. etc.   I was just estimating.

I'm always steppin' in and out of crap!

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Oct 26, 2007 01:22PM balletgirl wrote:

Thanks lini.  Hugs.

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Mar 13, 2008 10:04PM hapygirl-1 wrote:

Hi, Im out here in Newport Beach, CA. I had a left brest mastectomy with immediate reconstruction.  My hospital bill for 2 nights was 42,000 and my insurance paid all but  my 200.00.  My breast surgeron, the one who removed my breast was 1,400.00 the anathesia was seperate, the labs and other charges were all paid but my 15% copay.  I used a high end plastic reconstructive surgeon and ended up with amazing results and beautiful breasts.  He used an implant and then he agumented the othe breast.  For a good job out here in CA its about 25,000 to the plastic surgeon alone.  My insurance paid all but 10,000 of the bill for his services and I am appealing that right now.  Im responding to this because I have not been able to find any one who has used a high end plastic surgeon in CA to do their breast reconstruction to compair prices. There were other surgeon's who could do breast reconstruction, but why bother.  Most of the surgeon's pictures that I saw, looked worse than not having a breast.  My breast has feeling and the plastic surgeon is an amazing magician.  Without him, I would not have come through this as a hapygirl.

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Mar 20, 2008 08:22PM, edited Mar 20, 2008 08:23PM by auntiec

Lucky to be in NewPort Beach! I love your city. I had reconstruction done here on the other coast in NJ by a high end surgeon with excellent results. My reconstruction was done on both breasts. His cost NOT including nipple reconstruction was $28,000. The proceedure was latisimus dorsi. My insurance only paid $6,500 of this. I am trying to fight this so would be most interested in hearing what others paid for both mastectomy and reconstruction. They claim this is "usual and customary". I hope you are healing well.

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Mar 21, 2008 11:03AM cindiedee wrote:

I don't want to rock the boat on any of this but I had PBM with SGAP reconstruction last May - and I had LOTS of complications - but am fine now.  However, that being said, my bills were a little over $300,000!  I paid my $1000 deductible and that was it (plus meds, travel, hotel, meals, etc 'cause I had to go out of state).  Because I chose SGAP recon, it takes 2 PS and it took 11.5 hours for the initial surgery - and they each charged $43,000 - then there was 3 day hospital stay.  Stage II was not so bad - had it done outpatient (and back to hotel) - took about 3.5 hours and - was around $50,000.  The $300,000 pricetag above included just about everything - but I had to go back in hospital for a week (wound dehisce) and was on a wound vac all summer - that, alone, was $4000 a month plus meds, plus three times a week doc visits.  But - this is all unusual-just my luck I had all the complications!  But it was soooo worth everything I went through - no more mammos, no more biopsies wondering if this was the time BC would strike (extensive family BC history).  I have reduced my risks from about 98% to about 2-5% and as my DH says "If you get BC after all this, then that is what God meant you to have" - I have done all I can and I just have to remain vigilant since there is still a tiny risk - but the HUGE risk I had is gone.

Best of luck as you go forward!  Hugs, Cindie

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Mar 23, 2008 12:01PM auntiec wrote:

Hi Cindiedee
Boy it sounds like you had quite a summer last year. I had some wound complications too but yours sound much more serious. Would you mind telling me what state you had your surgery done in. Were the surgeons in your insurance network?

Thanks. I am glad you are well ad in such a good space.

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Mar 23, 2008 12:43PM cindiedee wrote:

AuntieC - I went to Drs. Kline and Craigie in Mt. Pleasant, SC - right across the bridge from Charleston.  I want to reiterate that none of my problems were the doc's fault - my weird body just didn't like sutures, etc.  And, I had NO problems with the flaps and new boobs - all my problems were in my butt cheeks where they harvested the "new boobs" from.  But I would still do it all again - no questions asked.  I now don't spend my days wondering if this was the day, the week, the month, the year that BC got me - strong family history - my mom died 3 years ago from her 2nd bout of BC and let me tell you, it wasn't pretty - cancer of any kind is an awful death and involved terrible pain and suffering.  And I watched my sister - who had her first lumps removed at 18 years old - by the time she was 39, she was on her 3rd bout of BC (and at that time, she had 7 more lumps to remove) - she finally had a BM with implant recon (all that was available at that time) - science has improved so much since that time and how awesome is it that they can use butt cheeks, ab fat, etc to build us new boobs - we are living in lucky times for sure.  I also had more than my fair share of lumps, biopsies, etc - all the docs said it wasn't "if" I got BC, it was "when" - so that is all I needed to know. 

I hate to hear that you had problems, too - some of us fly right through the surgeries and some of us have problems every step of the way (me) but thank the Lord for good insurance - we would have had to sell our house to pay for all this!

Hugs, Cindie

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Mar 27, 2008 11:15PM hapygirl-1 wrote:

Hi there, I couldn't find the site where I was so took me a few days to get back.  My surgery didn't include the nipple either, thats coming up in a month.  It will be about 6,000 to the PS for nipple and areola, not including hosp, anathesia, lab or anything else.  I think my PS will send me to the Wicked Chamber Tatoo Parlor, just kidding, he doesn't do tatoo but has someone who does.  I had a lot of trouble finding what other people paid for their recon so I really appreciate all you who wrote in.  Im waiting to hear from my ins co about my appeal.  But I feel pretty lucky for the price I paid and the results I got after hearing about the cost to some women and the problems they had.  There needs to be information on charitable organizations for women who need money for reconstruction who have none (like me).  Why should a woman have to settle for anything but the best PS with high end advanced surgical skills because medical insurance comapnies have not acknowledged the newer techniques which demand a higher skilled and educated surgeons who deserve to be paid what he is worth and what we deserve after having breast amputation.  I wish the absolute best to you.

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Jun 6, 2008 12:55PM heatherof5 wrote:

hi there i am new here and need some support and questions answered if anyone would care to help me out.  i am 31 and had my first lumpectomy done at 29 with a hysterectomy soon following.  i have had 2 other biopsy's with a stong family history of all aunts and grandmothers with cancer.  my dr has recommended genetic testing of brach 1 and 2 genes, or prophylactic mastect. .  i do not have sisters and mother has two breast mamograms that have come back bad but refuses to go back ( her theory is what she doesn't know won't hurt her) so my aunts were diagnosed in their 30's and now i am trying to make an educated decision between genetic test, continued painful biopsies and prophylactic mastectomy.  please help

thanks

heather 

life is not measured by the breaths we take but by the moments that take our breath away

Dx 6/21/2008, Paget's
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Jun 6, 2008 01:09PM lvtwoqlt wrote:

Heather, sorry to hear of your history. My mom's sister died at 38 with ovarian cancer and my mom was dx at age 63 with invasive lobular cancer. My mom did the BRCA test and was negative but at age 44 I started having abnormal mammos resulting in biopsies and lumpectomies for ADH (pre-cancer). Last year at age 46 my mammo was abnormal for the 3rd time and this time it was DCIS. After my 2nd abnormal mammo/biopsy in 18 months my surgeon suggested bilat mast, this was before the DCIS dx. You can ask to go to a genetic counselor to do a family tree of cancer and see what the odds are that you are BRCA positive. For me the bilat mast last year was worth stopping the biopsies and wonder when will it become cancer.

You might want to start a new conversation/thread and ask your question because this is an old thread and you might get more response with a totally new thread.

Sheila

Women are like tea bags, we don't know how strong we are until we were thrown into hot water. Eleanore Roosevelt Diagnosed ADH Feb 2005, ADH Sept 2006

Dx 4/27/2007, DCIS, Stage 0, Grade 1, 0/7 nodesSurgery 02/12/2005 Lumpectomy (Left)Surgery 09/10/2006 Lumpectomy (Right)Hormonal Therapy 10/12/2006 TamoxifenSurgery 06/01/2007 Mastectomy (Both)
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Jun 6, 2008 02:11PM heatherof5 wrote:

thank you for the response sheila.  how do i start a new thread??? sorry i am new at this.

life is not measured by the breaths we take but by the moments that take our breath away

Dx 6/21/2008, Paget's
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Jun 6, 2008 02:16PM, edited Jun 6, 2008 02:17PM by lvtwoqlt

on the topic page (high risk women) just under the title, is a box that says start a new conversation. click on that box and put in the title of your conversation then fill in the body with your question. I hope this helps you out.

Sheila

Women are like tea bags, we don't know how strong we are until we were thrown into hot water. Eleanore Roosevelt Diagnosed ADH Feb 2005, ADH Sept 2006

Dx 4/27/2007, DCIS, Stage 0, Grade 1, 0/7 nodesSurgery 02/12/2005 Lumpectomy (Left)Surgery 09/10/2006 Lumpectomy (Right)Hormonal Therapy 10/12/2006 TamoxifenSurgery 06/01/2007 Mastectomy (Both)
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Jun 6, 2008 02:27PM heatherof5 wrote:

thank you so much and sorry to bother you :)

take care

heather 

life is not measured by the breaths we take but by the moments that take our breath away

Dx 6/21/2008, Paget's
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Jun 6, 2008 02:29PM lvtwoqlt wrote:

It's no bother, it took me a little bit of time last year to get used to nagivating the boards.

Sheila

Women are like tea bags, we don't know how strong we are until we were thrown into hot water. Eleanore Roosevelt Diagnosed ADH Feb 2005, ADH Sept 2006

Dx 4/27/2007, DCIS, Stage 0, Grade 1, 0/7 nodesSurgery 02/12/2005 Lumpectomy (Left)Surgery 09/10/2006 Lumpectomy (Right)Hormonal Therapy 10/12/2006 TamoxifenSurgery 06/01/2007 Mastectomy (Both)
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Sep 21, 2009 09:50PM HeatherLL wrote:

My name is Heather, I'm BRCA+ and just had my prof. bilateral mastectomy with reconstruction last month.  The original question was about the cost.  I just received my bill and the total was about $47,000.  This includes pretty much everything. . . . I'm just floored.  We have a $5,600 deductible and then co-pay 50% of everything after that.  Never would I have chosen this health insurance plan had I known I would be going through all of this! Of course, that's just how life works.  We are in the process of adopting our 3rd baby from Korea, not now. . .   All the money we had saved is now GONE!  It is SO frustrating, we will be paying $25,000 out of pocket.  W

We are in OR, though I would add that. 

HeatherLL

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Sep 25, 2009 10:40AM tabbysis wrote:

I had bilateral prophylactic with immediate reconstruction done in May 08; my entire experience with all procedures and stages of reconstruction; insurance was billed over $300,000.  Again; mine was NOT breast cancer but Inflammatory Breast Disease with strong family history of Breast CA   

Let It Be.....There will be an answer....Let It Be.

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May 7, 2010 08:49PM mbsoxr wrote:

Does anyone know if Medicare will pay for a PBMx without going thru another biopsy & lots of tests?  I have posted my story in several places, but can't get any answers.  Found this thread, so will try again!

Last week I had a good mammo of the left breast at 9 months check up following lumpectomy for DCIS with Mammosite rads, but got called back to look at new calcifications in right breast at site of 2003 IDC tumor bed (lumpectomy w/37 rads followed).  Then had ADH in same breast in 2005 with another lumpectomy...  Took Tamoxifen & Femara till late 2008 when I had a small stroke.  Then left breast 2009.  Breast radiologist last week suggested I wait for 6 months & then take another look.  I am 70 years young, with very dense breasts & lumpectomy in June 2009 was 100% ER+ and 75% PR+.  I want to have a bilateral mastectomy soon, rather than wait, so made an appointment with my breast surgeon for next week for hubby & I to talk about having this done with no reconstruction.  Talked it over with my PCP this morning, who feels it will be a good move now while we are both fairly healthy - my husband is 72 & very robust, but who knows the future?  I have diabetes & lots of related complications, but am stable now.  Had good talk with my GYN, & she believes I should do it now, though emphasized it is my personal decision... 

 I am so tired of the stress of mammo call-backs and waiting for biopsy reports...  All of mine have started with "we need to look at some calcification clusters", so I am certain about this one... I don't even want to have a biopsy, either - I just want the mastectomies.  Does anyone know if Medicare might cover this?  I have no family history, I am the history!  I want to just have the surgery & be done with the stressful waiting!

 Thanks for any information!

Mary 

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Mar 29, 2011 12:09AM, edited Mar 29, 2011 12:11AM by Pinkribbonhope

To Sandra1957

Did you have to pay any money down when you went in for the surgery? I am looking for a way to get a prophylactic mastectomy without having to put so much money down.

Deborah Anderson

Dx 8/23/2010, IDC, 3cm, Stage IIIa, Grade 3, 5/15 nodes, mets, ER-, HER2-
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Mar 29, 2011 11:08AM moogie wrote:

 The surgery is cheaper than a single round of chemo.

I may have paid out about $7K over time and insurance kicked in for other things.

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