This week, Dr. James Craigie and office manager Gail Lanter of The Center for Natural Breast Reconstruction answers your questions.
Q: Hello! I am a breast cancer survivor. In 1995, I was diagnosed and had my mastectomy and reconstruction all at one time. It was a 13-hour surgery.
Lately, I have been experiencing some pain like a pinching around the flap area. Is this normal? Perhaps scar tissue? Also, what can cause this? Most mammogram techs will not do both breasts during mammograms; they say there is no need. But this makes me a little scared. What if the pain is cancer coming back in that area? Also, could weight gain contribute to this discomfort? I appreciate your insight.
A: It is not unusual for aches and pains to develop in the area you had surgery. If you have had weight gain then changes in the breast shape could cause pulling on the scars from your surgery. A lot would depend on the type of reconstruction you had. You should definitely have either your surgeon or cancer doctor examine you to determine if they notice anything suspicious. If so they may need to perform some type of test to get more information. They might consider an MRI or ultrasound. Our practice is dedicated to breast reconstruction and we are not experts at screening for breast cancer or the treatment of breast cancer.
I would definitely recommend you follow up with one of your doctors if your discomfort persists. I do not routinely have patients undergo screening mammograms of their reconstructed breasts. I hope this helps and that everything works out okay.
Dr. James Craigie
Q: I have the gene mutation, BRCA 1. I am from Ashkenazi Jewish descent. Many family members have been diagnosed before the age of 40. I have a scheduled prophylactic mastectomy with DIEP flap surgery scheduled for the end of May. I received a call this morning that Humana will not cover prophylactic surgeries. I know there’s got to be a way and that’s why I’m writing you. They’re telling me that my physicians can file an exemption or determination letter. Is this the best way to go about this? Do you have any advice for me on what I need to or ask my doctors?
A: I am sorry that you are having trouble getting information about the coverage of a prophylactic mastectomy. That can make a difficult situation even harder to deal with! Without having all of the info about your particular Humana plan, I can offer you general information that may help. You can access here Humana’s most recent clinical policy regarding coverage of prophylactic mastectomy. It clearly says that a patient is eligible if she has a personal history of the BRCA 1 mutation so I am unsure why you are receiving conflicting information. Did you receive the call from a representative employed by Humana? If so, I would certainly initiate another conversation with them and identify this clinical policy.
Practice Manager, Center for Natural Breast Reconstruction
Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!