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Topic: Bilateral skin sparing mastectomy, but not until Dec 31st :(

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Nov 7, 2019 11:15AM

San1975 wrote:

Hello ladies, I had my appointment with my breast specialist yesterday. We discussed my options and we came to the agreement bilateral mastectomy was for the best. Due to the size and location of the affected area. Unfortunately the first available date to coordinate with the plastic surgeon isn't until New Years Eve, not the way I wanted to bring in the new year but i'm trying my best to be positive. I did my pre-op testing which included a chest xray and they said there was a small nodule of my lung, so now I have to get a CT scan just to make sure its nothing...Has anyone else had a lung nodule that turned out to be nothing? The BS stated its most likely scar tissue from a previous illness but needed to get the scan to make sure. I'm holding onto that reason and not think the worse!

Dx 10/16/2019, LCIS/ILC, Right, 5cm, ER+/PR+, HER2- Surgery 12/30/2019 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement
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Nov 7, 2019 07:14PM OnTarget wrote:

I think I'd push it to Jan1 if possible, otherwise you are paying your out of pocket max in 2019 and 2020.

I had a liver lesion that the CT found which was benign (whew)! So totally possible!!!

Good luck!!!

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/13/2019 Zoladex (goserelin) Chemotherapy 8/5/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Nov 7, 2019 07:18PM - edited Nov 7, 2019 07:18PM by MinusTwo

Yes, I've had the same lung nodule that was discovered with I had imaging before cancer surgery 6 or 7 years ago. In 2017 I had a Spiral CT (low dose) and it was till the same. My pulmonologist says we don't need to test it again. Good luck

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Nov 7, 2019 07:26PM hapa wrote:

I agree with OnTarget re: pushing to Jan 1 to avoid paying your out of pocket max for two years. I also had lung nodules at dx, almost two years ago now. So far so good on those. We still haven't figured out what they are. After rads you couldn't see them anymore, so I don't suppose I'll bother checking again unless I have some sort of issue.

Dx 12/14/2017, IDC, Right, 3cm, Stage IIIA, Grade 3, ER+/PR+, HER2- (FISH) Hormonal Therapy 1/1/2018 Zoladex (goserelin) Hormonal Therapy 1/1/2018 Arimidex (anastrozole) Targeted Therapy 2/13/2018 Ibrance (palbociclib) Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/27/2018 Perjeta (pertuzumab) Targeted Therapy 3/27/2018 Herceptin (trastuzumab) Chemotherapy 3/27/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/22/2018 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 12/20/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Nov 8, 2019 07:17AM San1975 wrote:

Thank you for all the responses ladies, its good to hear that this could be nothing to worry about.

As far as the out of pocket expenses, can you elaborate on that? I'm not the best at all this insurance stuff, I have met my deductible for this year, so would that make a difference?

Dx 10/16/2019, LCIS/ILC, Right, 5cm, ER+/PR+, HER2- Surgery 12/30/2019 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement
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Nov 8, 2019 11:54AM - edited Nov 8, 2019 11:55AM by hapa

Generally, you will have a deductible and also an out of pocket limit.

When you start the year, you have to pay for your own treatment until you hit the deductible. Once you hit the deductible, your insurance will start to pay, but usually they will only pay a percentage and you will have to pay the rest which is called coinsurance, plus you still have to pay your co-pays ($20 or $40 per visit or whatever). It is usually something like 80% them and 20% you for coinsurance, or 70/30 or whatever your insurance plan says. But there is also a "out of pocket" limit, which will usually be several times your deductible. Whatever money you pay, including your deductible, your prescription co-pays, your office visit co-pays, and your coinsurance, when all of the stuff you have paid toward your care adds up to the out of pocket limit, you no longer pay anything. Once the new year starts, you are back at 0.

My deductible is $500 and my out of pocket max is $3500. Between herceptin infusions, tests, an implant revision surgery, check ups, and specialty prescriptions, I have hit the $3500 out of pocket max a few months ago. So I have scheduled a round of fat grafting for Dec 27 so I can get it in on this year's insurance. I do not expect to hit my out of pocket next year so long as I have no surgeries, I will just be going in every three months for bloodwork, zoladex shots, and an office visit. So it made sense for me to do the fat grafting this year; I will literally pay nothing for it, whereas next year I would probably end up having to pay at least 20% of the cost (I pay 20% coinsurance after I meet my deductible).

I assume you will be getting further treatment next year. Will there be radiation? Will you need more than one surgery? The pathology will probably be done and billed a few days after the surgery as well. There will be your follow up appointments and possibly some physical therapy if you have cording or other issues. If you have chemo there will be expenses related to that as well. So you will almost certainly at least hit your deductible again next year even if you do the surgery this year, and may hit the out of pocket max as well. But it depends on your treatment plan and your insurance plan. If you have already hit your out of pocket max this year, then doing the surgery this year makes better sense. Or if your deductible and out of pocket max are so high that you wouldn't hit them anyway. You can call your insurance company and they can probably tell you how much you have left on your out of pocket max, and also what your max is and what your coinsurance rate is. But there are probably bills that they haven't received yet so it won't be a complete picture.

I hope this helps.

Dx 12/14/2017, IDC, Right, 3cm, Stage IIIA, Grade 3, ER+/PR+, HER2- (FISH) Hormonal Therapy 1/1/2018 Zoladex (goserelin) Hormonal Therapy 1/1/2018 Arimidex (anastrozole) Targeted Therapy 2/13/2018 Ibrance (palbociclib) Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/27/2018 Perjeta (pertuzumab) Targeted Therapy 3/27/2018 Herceptin (trastuzumab) Chemotherapy 3/27/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/22/2018 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 12/20/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Nov 8, 2019 06:58PM San1975 wrote:

Hapa, thank you so much for that very thorough reply! Yes that helps a lot! I appreciate it! I will be having another surgery next year (not sure when) when they swap out the TE for the implants. I called my insurance today and they said it’s 80/20


Dx 10/16/2019, LCIS/ILC, Right, 5cm, ER+/PR+, HER2- Surgery 12/30/2019 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement

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