Thursday’s Surgical Consult, And The Plan At The Moment
Thursday’s consult with the local surgeon (Dr R) went very well. I had been anxious beforehand, since I knew that as far as Dr R knew, I was meeting to go over the plans to biopsy the suspicious area…I didn’t know how well he’d react to my saying I’d rather skip the biopsy and go straight to mastectomy instead. Well, he reacted quite positively. He seemed very knowledgable about what’s showing up on mammogram, about DCIS and about my options for reconstruction.
First we went over my history. He marveled over my current left-side recontruction and knew right away what surgeon I’d used in NOLA (the reconstruction technique I underwent in ‘01 was developed by this surgeon in NOLA; his group is world-renowned for this state-of-the-art procedure).
Then he went over the mammogram. First he complimented the film quality—they did “an incredible job” with the mammo, according to him. So if you’re local, I highly recommend Angel Williamson Imaging (in both Pcola & FWB). He said he sees about 6 microcalcifications, clustered together in a linear, branching pattern. The last two terms are highly suspicious for malignancy within the duct. He began by saying that due to their pattern, “we definitely need to take it out”. So I responded by saying, “Actually, what I really want is a mastectomy; I just found out yesterday that my insurance covers prophylactic mastectomy based on history alone, so…” and he interjected with, “Oh, good, then; you already have a plan!” 
So he agreed that to go ahead with mastectomy was a reasonable treatment plan for both the suspicious area and for my future health. Yessss.
He then added that there’s no way I’ll be able to get “this type” (referring to my left side) of reconstruction done here in the Pcola area. I rightfully assumed this already, but it was nice to hear the confirmation. He confirmed that plastic surgeons in Pcola only do reconstruction with implants—which are absolutely not an option for me. Same as I felt in ‘01, I’d rather have NO reconstruction at all, than implants. He also confirmed that to get the same, autologous (using my own redistributed fat) reconstruction I’d had before, I’d need to return to my surgeons in NOLA, a plan for which he gave his full support and recommendation.
He talked with me for a while about insurance coverage for this type of reconstruction. It’s tricky, I already knew. While insurance does cover reconstruction along with mastectomy, most insurers set limits on the cost, which isn’t a problem with straight implant reconstruction (which is relatively cheap), but this high-tech, autologous/microsurgical reconstruction that my NOLA surgeons do, comes at an immense cost (my total bill in ‘01 was over 100k for the entire surgery/hospital stay). Often insurance reimbusements don’t match the reconstruction surgeons’ cost, but instead of disallowing the difference, many reconstructive surgeons bill the difference to patients…which typically results in 10-30k out of pocket expense for the patient. I have no idea at this point if I’ll run into this scenario now, with my current insurance. This is one of the things we’re waiting to hear word about. Dr. R said that if there is a difference, that I should discuss it with my recon. surgeon, asking for him to write off the difference based on my being a returning patient and, in his words, “an extraordinary patient”. (Not sure what he meant by that, but perhaps it will help me!)
I’ll definitely do this if necessary; my recon. surgeon was a very sweet young man with whom I had a good relationship, so I hope he’d happily do this reconstruction for me, for whatever my insurance offers.
I thought it was nice of Dr. R to sit and talk with me and advise me about trying to get everything set up for surgery to take place in NOLA. What a great Dr! I’d ended up telling him that if we do run into the issue of insurance underpaying and my recon. surgeon not being willing to write off the difference, that there was no way I could pay for the tens of thousands of dollars in order to do it. So if that does end up being the case, I’ll just get a straight mastectomy with no reconstruction, because, again, implants are so not an option. He said that if it came to that, that he’d be happy to work with me and do the mastectomy for me. He was just a really caring, concerned doctor, and I appreciated his support for my plans.
So we ended our discussion with him wishing me luck in setting everything up in NOLA and for getting full insurance coverage for reconstruction. I asked him if delaying surgery for several weeks would be a danger (as far as leaving the suspicious area unchecked until I can get the mastectomy scheduled), and he said absolutely not. That he would be completely comfortable with me waiting a month, or possibly even up to two months until surgery, without any great danger. He did also point out that while the calcifications do point to malignancy, that it’s by far most likely to be intraductal, or, DCIS—which, while not a good thing, is NOT invasive…yet. So that helped me feel a bit less worried about the potential wait. He seemed very knowledgeable, and that along with my prayers for him to have wisdom in my case, makes me feel safe in waiting the necessary weeks until surgery.
Friday we got everything rolling in NOLA by calling my recon. surgeon’s office there (Dr. S). Liz, his patient liason, gathered all my info and started dealing with my insurance immediately to gain preauthorization for surgery. By the end of the day, she’d been in contact with them and said that everything was “going well” with them. She said that while Dr. S & his associates are well-booked, they always find a way to get surgery scheduled within one month if it’s a cancer case. She said I definitely count as a cancer case; even though I don’t have a diagnosis on this area yet, due to both my history and the fact that my surgery will be the biopsy on this area, it counts. Also, my being a return patient enables me to get higher priority, so she said they’ll get me in within a month. So that was a relief…as long as insurance cooperates, I’ll be getting my mastecomy within a month, and I’ll also find out what this area is…which is still a big issue to pray about.
**Please join me in praying that there will be no invasive cancer anywhere in my entire breast, as well as in the lymph node(s) that will be removed & biopsied.
And please pray that my insurance will 1) give NO problems authorizing this surgery right away, and 2) cover the entire recon. surgery bill, OR, that Dr. S will be willing to write off any difference that insurance doesn’t cover.**
I’ll update once we know more about the insurance and whatnot, but for now, that’s where I’m at. I’m just in awe of how God has moved these things in my favor. I couldn’t see how Thursday’s consult with Dr. R would end without confusion or frustration, but it ended in neither. It ended with amazement at yet another positive step being made. So many thanks for the prayers; they’re working.
