AABCP Politics of Breast Care

What is a Mastectomy?

2012-02-13T13:24:00.003-06:00

A mastectomy is an amputation! It cuts off a body part.

The word, Mast-ectomy, means just that, “the surgical removal of thebreast”. But because it’s a breast andbecause we have wrapped breast cancer and all that is associated with it in“fluffy pink clouds”, the underlying issue, an amputation due to disease, is icedover or forgotten.

There are several types of mastectomy butthey all fall into three basic categories: simple, partial and radical. A simple mastectomy, which is anything butsimple, removes the breast. A partialmastectomy, which includes, lumpectomy, quadrantectomy and segmentectomy is abreast conserving surgery that only removes that which has been shown to bediseased; leaving as much remaining tissue as possible; a faux breast if youwill. A radical mastectomy, contrary topopular belief, is in still in use and removes everything: breast, muscles, bonesligaments, lymph nodes. There are of course, surgical proceduresthat cover the ranges in between these three basic categories.

Also, contrary topopular myth, this is NOT when they put the new breast implant in. That comes later.Much, much later. Several procedures later.

But that, is foranother blog.

So what happens after a mastectomy? Most often, a woman leaves the hospital withsurgical drains. After a brief time,these are removed and she has sutures for up to 30 days depending on herhealing ability. She may be goingthrough chemotherapy, radiation or both at this time. A radio-chemotherapy series can takeweeks. After two months her surgicalwall may have healed well enough to wear an external breast prosthesis, butsurgical swelling and healing can take up to 1 year to fully heal. If her cancer is in remission, her insurancestill pays for the process for many States now have time limitations onreconstruction. And she is one of the 40% of women who has chosenreconstruction, another surgical process begins.

The bottom line?

While the mastectomy may be over in 48hours, the surgery is only one step in the ongoing treatment of the disease.

Scars of BreastCancer truly do last a Lifetime.

To help Breast Cancer survivors with post mastectomy needs, please visit the AABCP FOUNDATION

What's in a Name?

2012-01-18T10:12:00.000-06:00

Before I start, I must in all good conscience warn all who are easily offended or upset. This blog entry contains descriptive nomenclature.
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Ever tried to use the dictionary to look up a synonym for the noun "breast"? Bet you won't believe what you find. It may shed light onto the ongoing stigma that society has placed on the word and the body part.

Here's what I found.

Admittedly, there were a few that were new, even to me.

The definition of Breast, as found on dictionary.com listed: bosom, mamae, the source of milk, the source of emotion. No Seriously?

Now onto the Slang Thesaurus at onlineslangdictionary.com:

babylon – balcony – bap – bazonga – bazoom – bee sting – bittie – bolt-ons – boob – boobage – booby – breasticle – bust – cans – charlies – chesticles – chest puppies – fun bags – gazongas – girls, the – headlights – hooter – jug – lungs – mammaries – melon – moob – mosquito bites – naa-naa – puppies – rack – sideboob – sweater puppies – T and A – tatas – tig ol' bitty – tig old bitty – tits – titty – tracks of land – twins, the – underboob

Personally, chest puppies and fun bags tied for my favorite!

Is it any wonder than, when we attempt to have an honest and somewhat adult conversation about external breast prostheses, those items used to restore physiological symmetry after a breast amputation, most people still get ridiculous?

So what? Well, so everything!

It is this pernicious view of a women's breasts that subtly affects all social beliefs including: 1) all women want bigger breasts 2) all women want and receive breast reconstruction post mastectomy 3) breast prostheses are only used to make a woman look good in clothes and therefore are not a medical item, consequently, they should not be paid for by medical insurance.

In 1998, Congress pass WHCRA, the Women's Health & Cancer Rights Act, which mandated private and group insurance (not Federal insurance, Medicare, or Medicaid) pay for reconstruction of an amputated breast and for revision of the unafected side, to create symmetry. There are several conditions and caveats, but the gist of the legislation is that, replacement of symmetry was important enough to pass a Federal Law.

So why are we still fighting for insurance benefits from both private and government insurances?

The Other Side of the Statistic

2011-12-17T11:29:00.000-06:00

We have all heard the statistic 1 in 8 when talking about breast cancer. Most interpret it as, 1 in 8 women will be touched by or diagnosed with breast cancer. But how do statistics translate when we talk about breast cancer survivors?
Let's look at a few other statistics:

Some 195,000 Breast Amputations are performed annually
Over 2000 men are diagnosed with breast cancer annually
An estimated 2.3 Million women are LIVING with breast cancer

So while "1 in 8" underlines the urgent need for breast cancer research dollars and awareness, These other statistics demonstrate the need for community awareness and health care benefits for breast cancer survivors.

First let's remember that a mastectomy is and amputation.

Breast prostheses, lymphedema treatments and surgical reconstruction and revision (that's a whole other blog!), are among the post surgical needs of breast cancer survivors post mastectomy. But surprisingly, state, federal and employer based insurances are quietly decreasing the amount of benefits covered by implementing large deductibles, time limits for actions and financial caps. These actions creatively control costs while adhering to state and federal legal requirements. It is not unheard of for an insurance policy to have a $5000.00 annual deductible.

Still don't believe me? Medicare doesn't pay for custom breast forms or lymphedema sleeves! Neither do many state Medicaids. Currently twenty-six states have laws that further curtail WHCRA, Women's Health and Cancer Right's Act, which was a landmark bill passed in 1998 that guaranteed:

that group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you. This required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema.

Unfortunately, and this something that many do not realize, WHCRA does not apply to Medicare, Medicaid or other Federal and State programs.

The one certainty? Post-mastectomy breast care is an ever increasing casualty of health care politics.

For more information on Breast Care Politics follow us @speakoutAABCP or on AABCPRadio

"Looking Good"

2011-12-13T10:47:00.000-06:00

I was recently reading a post about H.R 2233, a bill currently before Congress that would allow Medicare recipients to receive a custom external breast prosthesis when a premanufactured prosthesis was inappropriate. The reader should be told that this item is actually a covered benefit and has until this year, 2011, been paid for by Medicare, albeit sporadically.

The post commented on the necessity or rather the lack thereof of the bill and the items. Paraphrasing, the commenter could not understand the need for coverage of an custom external breast prosthesis since the issue of breast prostheses post mastectomy was only "aesthetic in nature". And there were, "many off the shelf items that 'did the trick'".

I paused after reading this. I read it again. I went to my computer. And this Blog Series was born. I hope that the next several blog entries will raise awareness or at least question the way we approach post mastectomy options for breast cancer survivors.

A mastectomy, the surgical removal of a breast, is an Amputation. That's amputation with a "big A", An amputation complete with conditions, scars, surgical revisions and side effects. An amputation that at the very least removes a tumor or at the extreme removes bone, muscles, glands, tissue.

The replacement of a breast either through surgical restoration or by means of an external prosthesis, addresses to be sure, a psychological factor, but it is inherently based in the medical need for restoration of physiological symmetry.

The body has two of most things for a reason. Two arms, legs, eyes and breasts. Balance is the name of the game. Physiological asymmetry whether caused by trauma, amputation or other degenerative conditions, left untreated, will lead to the development of symptoms and serious conditions.

Post mastectomy treatment and items are more complicated that making a women, or a man, look good in clothes. I'm going to take a chance and say, I'm relatively sure individuals do not receive prosthetic arms, legs, hips, knees etc, just so they continue to "look normal". So why do we treat breast prostheses differently?

Throughout the next 5 blogs we shall look at breast cancer statistics, the mastectomy surgery, issues of physiological symmetry, social stigma associated with breast, and options for both men and women post mastectomy.

Waste..Fraud...Abuse

2011-05-09T10:15:00.000-05:00

There is no doubt extraordinary situations that constitute Medicare Fraud exist. However, it is becoming clear that this catch-all, very political phrase is being used to both demonize legitimate and ethical Medicare providers as well as to provide an excuse to reduce Medicare benefits.
In a recent conversation about post-mastectomy benefits, I was faced with horror stories of beneficiaries being contacted about the silicone breast prostheses they had received and these same beneficiaries were told that, "if they really didn't need these prostheses, Medicare Auditors would find out" and "they would loose their benefits". This type of "cost re-coupment action" is classified as "waste, fraud & abuse investigations" and heralded in triumph by politicians and administrators alike as cost savings events. But are denial of services or re-coupment of payments for legitimately and appropriately provided services, a "cost savings"? Internal edits, external audits of varying degrees including RACs, ZPICs encourage a "guilty until proved innocent" atmosphere within the CMS Medicare Program that has the very real potential to quietly reduce post-mastectomy benefits and services