The day started out really great with anticipation of my long awaited consultation appointment with Dr. Patrick Hsu of the Museum District Aesthetic Plastic Surgery.
I had researched this doctor, and found that he had great experience performing reconstruction procedures for tuberous breast deformity.
The office staff ensured me that they submit for insurance approvals for this procedure frequently at the time I made the appointment, as well as today before I actually saw the doctor.
If you aren't sure what tuberous (tubular) breast deformity is, you can gain a little insight here at Wikipedia's definition, or perform your own google search on the topic.
Here are some pics that I have gathered from around the net with women who have breasts similar to mine who have been diagnosed with tuberous breast deformity....
I get to the Dr.'s office, fill out the required paperwork and wait to be seen.
Dr. Hsu's assistant then calls my name and my husband and myself sit down and begin speaking with his assistant.
She goes over what I am looking to accomplish and again tells us that they will be able to submit this to my insurance company, but cosmetic procedures are sometimes hard to get approved, and tells us that any appeals would need to be taken care of by us (which I already knew from research on the issues).
According to our insurance companies policy, it states that cosmetic procedures are covered for a limited amount of procedures due to a medical necessity, but that birth defects are included.
Well.. tuberous breasts are a birth defect, so it should be covered. At least that is my thinking. I'm not going in to just get bigger boobs, but for a reconstruction.
His assistant shows us to the examining room and instructs me to put on a black terry cloth robe after removing my top and bra. I get changed and we wait for about 15 minutes.
The Dr. finally makes an appearance, and at first impression he seems to be very nice.
We talk for a brief moment, and then he opens my robe to examine me for all of about 10 seconds.
From that point on, his demeanor changes from nice and friendly to very standoffish.
He begins telling us that while I do have tuberous breasts, that my case is not as extreme as others and he will not bother submitting it for insurance approval.
He quickly dismisses any questions, concerns or comments that my husband or myself make, and tells me about how other women with different and more severe cases of breast deformities cannot get approved, so there would be no way that I could.
I ask him about calling my insurance directly and talking with them myself, and he quickly dismisses that idea saying, "You can call them, and they will most likely say that they will cover it and you can come back here, but I wouldn't give a recommendation because they wouldn't approve it". WTF?!
He then tells me if I go to another doctor and end up getting it approved, to call him.. because he would be very shocked if that happened.
I then asked him what procedures would he recommend, and he recommended the bernilli lift, augmentation, repositioning and reducement of the aerola.
Umm.. that is the same exact procedures for tuberous breast, so I don't see why it would be covered for extreme cases when it's the same thing.
He says because of a medical necessity.
Well.. (not to reduce the significance of cancer), but having breasts is not a medical necessity in the first place. So why then is a reconstruction of mastectomy patients covered? It's purely for appearance sake, correct? Maybe even because of emotional and mental reasons as well.
I have lived with these breasts for 32 years, and until recently I had no idea that my reproductive issues in the past are due to my tuberous breasts. Yes, I know it sounds a little funny, but tuberous breasts are caused by a low progesterone level which causes them to not form properly.
This low progesterone level had caused me to have 5 miscarriages before the doctors figured out (in part) of what caused the miscarriages.
So.. each day I look in the mirror and see my deformed breasts, I now know that they are the cause of my pain and suffering from the loss of 5 children. Should I have to deal with this the rest of my life? Is this not reason enough for insurance to cover this?
On top of that, milk production in persons with tuberous breasts is not that great if any at all. I was fortunate enough to be able to produce 'some' milk, for a short period, but had to use 1/2 breast milk 1/2 formula as I could not produce enough because of this deformity.
In ending the consultation with the doctor, I asked how much the procedures would cost, and he let out a whopping $10K!!!! OMFG!!
There is no way in hell that we would be able to afford that.
I'm pretty much at a standstill now, and completely devastated by this doctor and his lack of bedside manner.
He immediately left after giving the cost and I could not hold back the tears any longer.
I'm not sure which way to turn now, and very scared to even see another doctor to just be rejected again.
If anyone reading has any advice, or if you deal with this deformity as well, I would love to hear from you as I do not know where to turn now.
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