Sparing mastectomy/Diep - What was your recommended follow-up?

Posted by sandyjr @sandyjr, Sep 14, 2020

I have just completed bilateral skin sparing mastectomy with diep reconstruction after having DCIS (2007) in one breast, IDC (2018) in the other breast and discovery or CHEK2 genetic mutation (2019). My breast surgeon is telling me that I will need follow up mamos and MRIs. If you have had this surgery and diep reconstruction, what have you been doing or what does your doctor advise you to do for follow up treatment? I was under the impression that these would not be needed.

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@sandyjr

I had diep reconstruction in July. Since then I have noticed a few stray hairs around my and the PS suggested laser hair removal before nipple tattoos. Is it hugely expensive and does insurance ever pay for it (Medicare or BCBS)? So far they have paid for everything involved with the reconstruction.

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Did Medicare pay for DIEP Flap? I was told by surgeon that they do not.

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@betsyk

It was a fairly easy decision as I had three locations of DCIS spread out so best cosmetic result would be a mastectomy with reconstruction. My breast surgeon did give me the option of a lumpectomy with radiation. I also, felt that for me, a mastectomy would give me best possible long term outcome. I had breast cancer 25+ years earlier. This was a new primary. I hope this helps

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Thank you for the explanation. Is the new cancer on the same breast? What type of cancer did you have 25 years ago?

I feel the same in my case. Mastectomy as I have two tumors in my breast, plus a third mass that the ultrasound says that it's nothing.

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I had tubular carcinoma stage 2 now 30 years ago in opposite breast. I wish you good luck with your decision making and subsequent surgeries.

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@anjalima

Did Medicare pay for DIEP Flap? I was told by surgeon that they do not.

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Yes Medicare paid. What that didn’t pay, my other insurance paid. It was paid for 100%. I have regular Medicare A and B. I do not know about the Advantage plans.

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@sandyjr

Yes Medicare paid. What that didn’t pay, my other insurance paid. It was paid for 100%. I have regular Medicare A and B. I do not know about the Advantage plans.

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I have regular Medicare also. I was told by surgeon that Medicare did not even have a code for it and did not pay. If you have the code in your medical notes I would love to know if it. Thank you.

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@anjalima

I have regular Medicare also. I was told by surgeon that Medicare did not even have a code for it and did not pay. If you have the code in your medical notes I would love to know if it. Thank you.

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So far I found this…breast reconstruction deformity (N65.0), Hx of bilateral mastectomy (Z90.13), and personal history of malignant neoplasm of breast (Z85.3). I had the bilateral mastectomy and the diep flap reconstruction at the same time…about 10 hours. You will need a microsurgeon for the diep flap. Not all plastic surgeons are micro surgeons. Also, maybe your surgeon does not accept Medicare assignment in which case, I think it would not be covered. Where are you located? I am in NJ and would gladly give you my doctor’s name. He told me that everything would be paid for and it was. I had a bad experience finding a surgeon for the mastectomy. The first one I went to was rude and crude and told me that I was too old for diep flap and that I would have to have implants. She worked with a plastic surgeon and would send me to him. I couldn’t get out of that office fast enough. I found the microsurgeon and he directed me to a surgeon. I actually had 2 microsurgeons. While the breast surgeon was doing the mastectomies, the 2 microsurgeon each worked on a side and harvested the tissue from the abdomen and attached it to the chest. All sorts of stuff needed to be reattached so the moved tissue would have a blood supply. I think if I were you I would try to find a good microsurgeon and then they can direct you to a breast surgeon. Please feel free to communicate with me and let me know how you make out. I don’t think I would confront your surgeon as he must have a reason for what he says. It is possible that he doesn’t have experience with doing diep flap or is not a microsurgeon. I think I would shop around…go for a second opinion. I also think there is a law that if you have breast cancer, surgeries and reconstruction have to be covered by insurance if it part of your plan.

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@sandyjr

So far I found this…breast reconstruction deformity (N65.0), Hx of bilateral mastectomy (Z90.13), and personal history of malignant neoplasm of breast (Z85.3). I had the bilateral mastectomy and the diep flap reconstruction at the same time…about 10 hours. You will need a microsurgeon for the diep flap. Not all plastic surgeons are micro surgeons. Also, maybe your surgeon does not accept Medicare assignment in which case, I think it would not be covered. Where are you located? I am in NJ and would gladly give you my doctor’s name. He told me that everything would be paid for and it was. I had a bad experience finding a surgeon for the mastectomy. The first one I went to was rude and crude and told me that I was too old for diep flap and that I would have to have implants. She worked with a plastic surgeon and would send me to him. I couldn’t get out of that office fast enough. I found the microsurgeon and he directed me to a surgeon. I actually had 2 microsurgeons. While the breast surgeon was doing the mastectomies, the 2 microsurgeon each worked on a side and harvested the tissue from the abdomen and attached it to the chest. All sorts of stuff needed to be reattached so the moved tissue would have a blood supply. I think if I were you I would try to find a good microsurgeon and then they can direct you to a breast surgeon. Please feel free to communicate with me and let me know how you make out. I don’t think I would confront your surgeon as he must have a reason for what he says. It is possible that he doesn’t have experience with doing diep flap or is not a microsurgeon. I think I would shop around…go for a second opinion. I also think there is a law that if you have breast cancer, surgeries and reconstruction have to be covered by insurance if it part of your plan.

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Also in NJ! Wow! Would love to know name.

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@anjalima

Also in NJ! Wow! Would love to know name.

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Did you have a “ deformity” from a prior surgical intervention?

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@sandyjr

Yes Medicare paid. What that didn’t pay, my other insurance paid. It was paid for 100%. I have regular Medicare A and B. I do not know about the Advantage plans.

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The previous codes were from my hospital reports. The Medicare codes for the mastectomy and diep flap…removal of breasts (19303-RT) and 19303-LT), plastic surgery to reconstruct breast with muscle flap (19364-8250) assistant surgeon and plastic surgery to reconstruct breast with muscle flap (19364-50)…that one is for the primary plastic surgeon. There will be additional surgeries…revision and nipple construction and maybe more. I don’t have those codes handy but can look them up.

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@anjalima

Also in NJ! Wow! Would love to know name.

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I sent you a private message. Let me know if you get it.

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