Tag Archives: breast implants

Do Patient Empowerment & Squeamishness Mix?

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This post originally ran a year ago. I dusted it off because I was looking up medical terms online last night and encountered some photos that brought the old squeamishness back. -Jackie

 Patient empowerment is all the rage lately. While I distrust the way the “e” word sometimes verges on ideology, I’m all for learning what’s happening when we get that front row seat to medicine thanks to cancer or another big diagnosis.

But how best to learn if you tend to be medically squeamish? My previous patient experience was limited to an annual visit, with a handful of garden-variety illnesses and the inevitable screening tests required once you hit your 40s and 50s. I’ve never had a problem with those tests, or with needles, but once I learned my breasts were going to be the focus of a cancer adventure I felt a bit queasy.

The thing is, I can’t even stand nipple rings. Back when my husband Bruce and I used to take his Harley to the big bike rally in Sturgis, S.D., I averted my eyes a lot. I found myself doing the same thing now as I loaded up on breast cancer books. How do those DCIS cells act? Sure. An illustration of a nipple floating off into space during a mastectomy? Not so much.

I wanted to know what to expect without getting too much detail, if that makes any sense. So while I learned enough to know I wanted implants instead of tissue replacement surgery for reconstruction, I didn’t read about surgery details, and I couldn’t look at before and after reconstruction photos available online.

I had gone through the mastectomy and first-stage reconstruction before I became curious about things like how my surgeon was able to balance tissue removal and skin preservation during the mastectomy, or how my plastic surgeon was able to recreate a nipple.

Believe it or not, I actually watched him do it, since it only required local anesthetic. If you had asked me five years ago if I wanted to watch myself getting a nipple built, I probably would have yakked on your shoes. But this was my fifth surgery in nine months, so I had gotten used to it. And I’m really glad I watched because it was fascinating.

But that’s me, and it happened over time. You may want every last detail, or you may prefer letting the experience wash over you. And there’s nothing wrong with that. I would recommend learning enough to be able to make an informed treatment choice, and giving yourself enough time to make that choice.  Whether you ever learn what they do with those scalpels or watch them do it is totally up to you.

For the record, nipple rings still gross me out.

Do Patient Empowerment & Squeamishness Mix?

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Patient empowerment is all the rage lately. While I distrust the way the “e” word sometimes verges on ideology, I’m all for learning what’s happening when we get that front row seat to medicine thanks to cancer or another big diagnosis.

But how best to learn if you tend to be medically squeamish? My previous patient experience was limited to an annual visit, with a handful of garden-variety illnesses and the inevitable screening tests required once you hit your 40s and 50s. I’ve never had a problem with those tests, or with needles, but once I learned my breasts were going to be the focus of a cancer adventure I felt a bit queasy.

The thing is, I can’t even stand nipple rings. Back when my husband Bruce and I used to take his Harley to the big bike rally in Sturgis, S.D., I averted my eyes a lot. I found myself doing the same thing now as I loaded up on breast cancer books. How do those DCIS cells act? Sure. An illustration of a nipple floating off into space during a mastectomy? Not so much.

I wanted to know what to expect without getting too much detail, if that makes any sense. So while I learned enough to know I wanted implants instead of tissue replacement surgery for reconstruction, I didn’t read about surgery details, and I couldn’t look at before and after reconstruction photos available online.

I had gone through the mastectomy and first-stage reconstruction before I became curious about things like how my surgeon was able to balance tissue removal and skin preservation during the mastectomy, or how my plastic surgeon was able to recreate a nipple.

Believe it or not, I actually watched him do it, since it only required local anesthetic. If you had asked me five years ago if I wanted to watch myself getting a nipple built, I probably would have yakked on your shoes. But this was my fifth surgery in nine months, so I had gotten used to it. And I’m really glad I watched because it was fascinating.

But that’s me, and it happened over time. You may want every last detail, or you may prefer letting the experience wash over you. And there’s nothing wrong with that. I would recommend learning enough to be able to make an informed treatment choice, and giving yourself enough time to make that choice.  Whether you ever learn what they do with those scalpels or watch them do it is totally up to you.

For the record, nipple rings still gross me out.

Cracking the Medical Billing Code

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First, I better own up to that being a very misleading headline. I am far from cracking the code (and I used to write documentation for medical billing software!), but I did notice something that didn’t add up when I had a mammogram a couple of weeks ago.

I mentioned in a recent post that when I went in for my second annual postmastectomy screening, the tech told me they needed to code it as diagnostic because of my implant. In that post, I wondered whether the diagnostic mammogram would be more expensive.

I found out it was not; however, the full covered cost was applied to my deductible, leaving me responsible for $145. I asked my insurance provider if the full cost of the routine screening also would have been applied to my deductible. The phone rep said I would only have been responsible for a 10 percent copay, or roughly $14. So I called the medical center billing department and asked them to go back and question the diagnostic code.

Implant or no implant, the reason for my visit was my routine annual screening. I don’t know if they’re using this coding for anyone with implants or if it was just me, but I feel like I landed in the middle of a Kafka novel. If I don’t get a satisfactory explanation, I will argue this one until the cows come home.

The funny thing is I went through $83,000 worth of demolition and reconstruction and never ran into anything this goofy until now.

I mentioned this was my second annual postmastectomy mammogram. You may be wondering whether something’s changed since the first one, and I wish I could tell you. I think I was just so relieved the results were normal that I didn’t pay attention. It’s quite possible I paid a $145 stupidity tax.

Don’t be like me. Whether it’s your breast cancer, your husband’s gallbladder or your child’s asthma, pay attention to those bills. If they don’t make sense, get someone on the phone and make them explain it.

The Letter

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I had my second postmastectomy mammogram on Wednesday. Mammograms have never scared me and they still don’t. I wondered if they might once I had breast cancer, but there’s comfort in routine. Same room, same tech, same digital mammogram equipment with the oddly beautiful name Selenia.

One thing has changed. Because of the mastectomy, only the breast on the right side needs a mammogram. When I reminded the tech I had an implant–I had it augmented and lifted so they’d match better–she had to figure out how to bill me. “It isn’t a screening anymore,” she said.

“But I’m still getting screened for cancer,” I said.

She agreed but said now it’s called a diagnostic because of the implant, which explains the letter I got two days later. It said the results are normal/benign, “however, the area of concern in your breast that prompted this exam should be further evaluated by your physician or other health care provider.” They had it in bold type for extra emphasis. Then they said the area of concern “should not be ignored despite a normal mammogram.”

I had to read it twice because it sounded pretty harsh for a good news letter. I briefly thought, “What area of concern? What the heck are you people talking about?” Then I remembered that because of the implant, my visit was classified as a diagnostic visit, not a routine screening. Although I now understand why I got the diagnostic form letter instead of the routine screening form letter, it was a bit jarring. And the tone could stand some improvement in any case. A simple one would be removing all the bold type. If something has prompted a diagnostic mammogram, we get it that we need to pay attention. I”m pondering contacting them with some friendly editing advice.

The other thing I’m wondering about is how the costs of my diagnostic mammogram compare to the costs of a screening mammogram. We used to joke about half-price mammograms after the mastectomy, but I think the opposite might be true. The radiology tech explained that they had to take more pictures. True, but you’re taking pictures of one breast when you used to take pictures of two. I didn’t get into that with her because she is a very nice person and doesn’t make the rules, but I plan to find out what the cost differences are. Call me jaded but I wonder if the diagnostic mammogram doesn’t cost more. I’d be happy to be wrong.

Cold Breast, Warm Heart

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When it’s your turn to get breast cancer, you become kind of a student of the topic. As soon as I was diagnosed with ductal carcinoma in situ (DCIS), I headed online  and bought a stack of books so I could research of all these new terms like DCIS and comedo and cribriform (types of cells that constitute DCIS). Once I realized I’d be getting my breast reconstructed I started studying how reconstruction works as well. I had to work my way up to that particular brand of research; in those days, I was still squeamish about medical details.

The one thing I didn’t see mention of in any of the books or online resources I checked out is that after you’ve had reconstructive surgery with an implant, your breast may feel cool to the touch. Which makes sense when you think about it; the implant (mine is silicone) isn’t going to heat as quickly as living tissue. 

So I thought I would share this as one of those little details you’re not likely to hear about. Is it a bad thing? No, just something to be aware of. It took me awhile to even notice the change.  It’s something I certainly never would have thought to ask–”Oh, by the way, is it going to feel cold?” It wouldn’t have been a deal breaker in any case. Tissue replacement was never an option for me because I wanted to limit surgeries to one area of my body and I was completely comfortable with the idea of implants. Still am.

I’m curious to hear about anyone else’s discoveries along these lines. What’s a small (or big) detail that you never heard about before you got there? What surprised you on your journey?

I Had Breast Cancer and All I Got Were These New Implants

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The first anniversary of my second-stage reconstruction and augmentation was December 1st. Because I’m taking part in a 10-year study for silicone implants, I had a required follow-up visit with my plastic surgeon on Friday. The conversation was one you can never imagine having until you’ve been there–in addition to an overall progress report, we ended up chatting about how the girls line up (pretty darn well). I had to rate my overall satisfaction with the results and was able to truthfully say I am ”definitely” pleased on the “definitely” to ”not at all” scale of the form he had to fill out. I could tell he was pleased too, and he’s a perfectionist (a great quality for a plastic surgeon to have). He said my overall results were excellent.

As part of the study, I have to fill out a questionnaire for each breast. And I get paid for it–$20 for the augmented one, and $100 for the follow-up visit and longer questionnaire for the mastectomy one.

I’m not sure how helpful my answers will be. Both questionnaires use a “Disagree strongly” to “Agree strongly” or 1 to 4 scale, and I always wish they were essay questions. It’s really hard to assign a numerical value to something like how attractive you feel. Does 3 mean I think I hold my own with the over-50 crowd but I’m no Michelle Pfeiffer? Does 2 mean I lack self-esteem?

Some of the questions/statements (“I feel worthless”) are clearly gauging mental health. Others border on trippy. I did the short questionnaire over the phone and may have tested the interviewer’s patience. At one point, she said,“Thinking about your breasts, how confident are you in social situations?” I replied, “I usually don’t think about my breasts in social situations.” I think I finally landed on 3 to mean “I’m not sure my breasts affect my confidence.” It reminded me of an old Saturday Night Live sketch. Gilda Radner was Annette Funicello in one of those 1960s beach movies, and introduced herself by saying,”Hi, I’m Annette and these are my breasts.”

I’m sure whoever designed the study knew what they were doing. But I still wish they were essay questions.