Over the last three+ years, I have heard more boob discussions than one should in an entire lifetime. I have also had the opportunity to see some incredible breast reconstructions (and some just okay ones) and have had so many conversations regarding my own “breast situation.” I love how people love to add those little comments in like, “Oh hunny, go bigger. You can afford too!” Again, it wasn’t until I really started paying attention that I thought to myself, “wow…maybe I am on the smaller side…” and until some women, and my husband for that matter, helped to point it out.
One might ask how you could not know that you are of the more “average” or even below average size but until all of this BRCA stuff came up, I just never really noticed! You would be amazed what a group of BRCA women talk about (or show you) when you put them in a room together! It also probably didn’t help that I wore the wrong cup size for the majority of my teenage/adult years so maybe I was just in denial about my boobs or just didn’t care.
The best part was last summer I went wine tasting, had maybe one two many glasses of wine, and nonchalantly asked my husband (in front of another couple might I add), “Out of all the boobs you’ve EVER touched, how do mine compare in size?! Small, medium, or large?” I was dead serious and demanded that he answer me. I thought he might fall over or pass out. Now, let me remind you, I had had A LOT of wine and wouldn’t let it go until my poor husband admitted to me, “I guess they are on the smaller side.” I was actually surprised! I knew he wouldn’t say large but I thought to myself, maybe medium? I guess he was thinking there was an extra small category and at least I am not in that. My poor husband just couldn’t win and the couple with us found it to be totally amusing.
“Foobs”: Breast shopping
If I had a crayon or eraser, my breasts are NOT the first thing I would add or erase from myself. Obviously if I didn’t know my boobs were that small, it’s pretty much the last thing I would go under the knife for but this is the hand I was dealt so if I am going to get new breasts you better believe they are going to look amazing! To get these amazing boobs, or “foobs” as us BRCA people call them, I must go boob shopping.
The better term is probably surgery and surgeon shopping but I like to refer to it as boob shopping or “Foob” shopping. Now, BRCA has A LOT of terminology and foobs is one of them. (ie. Fake + Boobs = Foobes) So, Foob shopping is the process of looking at all the different types of prophylactic mastectomies that are out there, comparing and contrasting them, and then finding the right surgeon. Once I have chosen my surgeon I am sure Chad and I will feel the type of breast we want and pick the size (totally weird, I know) but I am still in the earlier stages. I don’t even know if I want to go bigger. I think I just want them perkier and pushed together more so I can actually have some cleavage. Hell, if a girl has to get all her tissue removed and go through such a crazy surgery then I should at least get perky breasts.
I am pretty confident that I know what type of surgery I want which definitely narrows down my choices of surgeons because it is a highly new type of breast reconstruction and only a handful of physicians in the country are trained in this type of surgery. This does, however, cause some problems when it comes to insurance coverage and it also requires traveling. No one within 30 miles of DC is able to perform such a surgery which means I will have to travel to New York or Chicago and stay overnight in a hotel for nearly two weeks if I decide to go with this specific type of mastectomy. Again, another predicament. My choice would be New York because it isn’t as far and I have family near there but unfortunately it is looking like my insurance wants me to go to Chicago.
The surgery I want: the one-step/ direct-to-implant
During a typical mastectomy, the chest muscle and breast skin must be expanded over a period of several weeks to create a pocket of sufficient size to hold the implant therefore there are several procedures performed. Alternatively, stitching patches of acellular dermal matrix to the sides of the muscle or along the inframammary fold creates an instant pocket and more complete coverage of the exposed implant edges. This is called a direct-to-implant reconstruction or more commonly known as the “one-step.”
Direct-to-implant reconstruction offers three distinct benefits over traditional implant reconstruction including the following:
- Single-step implant procedure doesn’t require expansion
- Women who combine this procedure with prophylactic subcutaneous (skin-sparing) mastectomy and nipple-sparing mastectomy can complete their entire reconstruction in a single step.
- Acellular dermal matrix integrates into a woman’s healthy tissue so the breasts tend to look more natural
Who is calling the shots?
I would like to think that Chad and I are calling most of the shots when it comes to my healthcare but I do feel a little a little captive to my health insurance. It is important that I get the surgery and physician that I want but if I go out-of-network it would just be too costly. Of course, the plastic surgeon that I want in New York City is out-of-network. The facility/hospital is in network and the breast/general surgeon is in-network but he is not. This is so frustrating! I did speak to my insurance and they said that I have something called GAP coverage where, if there is no one within a 30 miles radius that does the procedure that I need/want, then I can appeal for in-network coverage. Whohoo! There is definitely not someone in this area that does the surgery so I think my chances are pretty good but we will just have to wait and see.
I will be attending the FORCE conference in June and have set up a consultation with the plastic surgeon for Chad and I to meet with. We will have to see what the doctor says, what my insurance approves and if Chad is as calm about this as he appears to be.
The more I talk about it with my husband, the more he wants me to stay local. There are great physicians in the DC area but with a more lengthy process. I have started to contact some of those surgeons to get consultations just to see what my options are. It would be nice to be home in my own bed versus in a hotel and I have such a great network of friends and family here. Also, if something was to go wrong, to be near my doctor would be a huge asset. We will have to see how all these consultations go.