Gynecomastia Reduction is one of the most frequently performed cosmetic plastic surgery procedures for men. Over the last 20 years, the number of Gynecomastia Reductions performed has increased 50% – from twenty-thousand in the year 2000 to thirty-thousand procedures last year. However, the examples I am sharing today are not your typical gynecomastia reductions.
Gynecomastia Reduction after Massive Weight Loss is a different operation than the typical gynecomastia reduction. The large amount of excess skin and extremely low nipple position require special attention to detail and appropriate treatment to achieve a great result. This patient had chest skin reduction (a male breast lift), reduction and repositioning of his nipples along with a tummy tuck to restore his physique after impressive weight loss.
Types of Gynecomastia Reductions
Male Breast Reduction techniques vary depending on the amount of tissue that needs to be removed. Small lumps of firm glandular tissue located beneath the nipple/areola complex (NAC) can be excised directly via a small incision around the edge of the areolae. Large reductions may also require liposuction to remove excess fat (aka pseudogynecomastia). Gynecomastia reduction associated with loose skin, or sagging nipples, is more challenging and is the topic of today’s Massive Gynecomastia Reduction Video. This situation is most commonly seen after large weight loss from either Bariatric Surgery or a change in lifestyle resulting in massive weight loss.
Massive Gynecomastia Reduction Video
The following Plastic Surgery Video Presentation shows several methods of Extreme Gynecomastia Reduction. These are common Post-Bariatric Plastic Surgery techniques, but are not the most common methods used for routine Male Breast Reduction. This segment is taken from my TV show Body Beautiful which airs on the San Francisco Bay Area’s News Station, KRON 4.
Post-Bariatric Male Chest Reduction with Tummy Tuck
The goal of Bariatric Surgery is weight loss and the health improvements that come along with it. The improvement, and sometimes the resolution, of diabetes and high blood pressure are frequently seen after weight loss.
On the other hand, massive weight loss also usually leaves behind a large amount of excess skin, and this continues to makes it difficult for patients to feel comfortable. Even with the loss of mass, redundant skin makes finding clothes that are flattering and which fit well difficult.
A massive amount of excess skin is apparent on the trunk of the patient below. His chest is deflated and overhangs laterally, and even in clothes, it looks like he has breasts. His abdominal skin excess is uncomfortable and a nuisance, especially at the belt-line.
Body Lift after massive weight loss including: chest reduction (massive gynecomastia reduction), areolar reduction, breast lift and abdominoplasty (tummy tuck). The early scars are more noticeable in the first several weeks to months after surgery, but will continue to improve and fade during the year or two after surgery.
A combination of Gynecomastia Reduction with skin excision and a Tummy Tuck was used to redefine his trunk. The scars beneath his chest are still healing and will fade with time. There is another scar running below the belt-line which allowed for the tightening of his abdominal muscles and removal of his skin laxity. When loose skin extends all the way around the waist, a Lower Body Lift is often the procedure of choice.
Gynecomastia Reduction Revision Surgery
Gynecomastia Reduction Revision Surgery is perhaps the most challenging of all Gynecomastia surgery. In the case below, the patient complained of still having breast fullness after a previous Male Breast Reduction. He had bottoming out of his chest skin resulting in the appearance of breasts in clothing. Paradoxically, he also has severe indentation of his nipples from the previous resection. This can happen when a large amount of breast tissue is removed.
The patient shown below was treated with skin excision and restoration of volume beneath his nipples to smooth his contour both in and out of clothing. Like the patient above, he has scars located beneath the breasts, but these have faded over time.
This patient had gynecomastia surgery prior to presenting to my office. Revision gynecomastia surgery was performed including restoration of volume beneath the nipples (left > right) and resection of the excess skin that remained along the lower chest. His scars have had time to heal and are less noticeable; however, individual results will vary.
Gynecomastia surgery can be rewarding and build self confidence. Prior to surgery, his sunburn was confined to the open collar area of his chest. After surgery, he was confident in his appearance and went shirtless. The unfortunate result was a burn to his entire chest. He got the sunscreen lecture, but I was also happy that he finally felt comfortable in his own skin.
You have heard it before and will hear it here again on the San Francisco Plastic Surgery Blog. Use of appropriate sun protection is recommended to help prevent skin cancer and premature aging of the skin. In the postoperative period, sun protection is especially important to help prevent the scars from tanning, turning dark and becoming more noticeable.
Breast Reduction for Men Consultations
As mentioned previously, the type of Male Breast Reduction shown above is usually only necessary after massive weight loss. There are exceptions, however, and I have had to perform this surgical variation for men after hormone therapy for prostate cancer and also for a gentleman whose breast enlarged massively with CoolSculpting®. Though rare, Paradoxical Adipose Hyperplasia (PAH) after CoolSculpting® is definitely not cool.
If you count yourself among the 33% of men who continue to have Gynecomastia after puberty, and you would like to learn exactly what treatment options are available for you, call (925) 943-6353 today, to schedule a private consultation appointment. You can also submit your questions via the contact form on this page.
Massive weight loss will shrink our volume, but does not reliably shrink our skin. In the before and after pictures above, breast volume is restored with breast implants. Sagging breast skin is tightened with a breast lift. Excess abdominal skin is removed, and the belly bulge caused by stretched out abdominal muscles, is flattened by tightening the muscle sheath.
Post-Bariatric Plastic Surgery is Plastic Surgery after Massive Weight Loss. Whether this is after a lifestyle change or after Bariatric Surgery, the amount of skin that persists after weight loss is often large and frustrating. This Post-Weight Loss Plastic Surgery Video reviews several of the most common treatments including: Lower Body Lifts, Tummy Tucks, Breast Augmentation, Breast Lifts and Arm Lifts. The results of Post-Bariatric Plastic Surgery are illustrated and narrated in this video with before and after pictures, which describe and demonstrate what Board Certified Plastic Surgeons can do for the skin excess that often occurs after weight loss.
Post-Bariatric Plastic Surgery Video
Extremity Tightening Procedures
The majority of skin tightening procedures performed after weight loss are for the trunk; however, the face, arms and legs can also develop excess skin. Face Lifts (Rhytidectomy), Arm Lifts (Brachioplasty) and Thigh Lifts can help with excess skin on the face/neck, upper arm and thighs. Below is an example of an arm lift.
Brachioplasty literally means arm changing. An arm lift can change the way an arm looks, feels and fits into sleeves.
Brachioplasty changes the arm by removing the excess skin that often hangs off the upper arm after weight loss. The skin is removed from the lower border of the upper arm, leaving a scar along the bottom of the arm. This is the only procedure that can remove large amounts of excess skin.
Post Bariatric Plastic Surgery Consultations
As an active member of the American Society of Bariatric Plastic Surgeons, post bariatric plastic surgery is an area in which I specialize.
The American Society of Bariatric Plastic Surgeons was formed by Board Certified Plastic Surgeons specializing in skin tightening after massive weight loss.
When searching for an experienced post-weight loss plastic surgeon, be certain to look for a Board Certified Plastic Surgeon who is a Member of the American Society of Plastic Surgeons. Additionally, members of the American Society for Aesthetic Plastic Surgery specialize in the cosmetic side of plastic surgery, and members of the American Society of Bariatric Plastic Surgeons demonstrate additional dedication to the cosmetic side of post-bariatric plastic surgery.
If you are in the San Francisco Bay Area and want to learn more about your skin reduction options after weight loss, call (925) 943-6353, to schedule your private consultation appointment.
Breast Augmentation Lift combines the Breast Enlargement of Breast Augmentation with the firming and shaping abilities of a Breast Lift.
The desire for the Best Breast can be divided into two areas: The best size and the best shape. This Breast Augmentation and Breast Lift Video discusses combining a breast lift with a breast implant. The procedure allows your plastic surgeon to maximize your results when both shape and size need modification.
Breast Augmentation Lift Video (Mastopexy Augmentation)
This Body Beautiful video segment from the San Francisco Bay Area’s News Station, KRON 4, reviews Breast Lifts combined with Breast Implants and illustrates the benefits of Augmentation Mastopexy with numerous Breast Aug Lift Before and After Photos.
The ideal breast size varies from patient to patient, and it is important to recognize that the more you do your homework in determining what size makes you happy, the easier it will be for your plastic surgeon to give you the result you desire. Most patients request a cup size in the C plus to D minus range, but you should try it out at home, first.
Buy a bra the size you feel you want to be and stuff it. Ziplock bags filled with rice are a simple way to adjust your breast volume. Try it with different clothing to see how you like it. Do your normal activities, and see how it works. Also, think about your overall body size and your activity level. Marathon runners often go smaller, to avoid the added weight and momentum.
Breast size is determined by the volume of breast tissue you have now, plus the volume of the breast implant. When you have a good shape, Breast Augmentation alone is used to enlarge the breasts to the desired size. For most women this is the procedure of choice. When the breasts are saggy, asymmetrical or tubular, a breast lift may be recommended to improve the overall esthetic of the breasts.
Breast Augmentation Lift Before and After Pictures
Deflated, post child birth or post weight loss breasts can be lifted, tightened and enlarged with the breast enhancing Mastopexy Augmentation. Larger lifts require longer scars. In this case, the healing vertical scar is seen on the lower pole of the breast. After this breast augmentation mastopexy, the breasts are fuller, firmer and lifted.
The ideal breast shape also varies from patient to patient. Most patients desire perky, teardrop shaped breasts. A Breast Lift reshapes the breasts by removing excess skin, lifting and firming the breast mound. When the upper pole of the breast is empty, a breast implant is used to add volume. A Breast Implant can balance the upper and lower halves of the breast, or it can enlarge the entire breast.
Breast Lifts come in many sizes. The most common are periareolar (around the areola/nipple), vertical (lollipop) and inverted T (anchor or keyhole). The amount of lifting needed determines the type of lift recommended. It is always desirable to choose the smallest lift expected to work. Smaller lifts come with shorter scars, but they lift less. Be sure to consult a Board Certified Plastic Surgeon near you to learn what is recommended for your particular needs.
Breast Augmentation Lift Consultations
When considering Breast Augmentation, with or without a Breast Lift, be certain to consult an experienced Board Certified Plastic Surgeon. They can explain your options and select the procedure most likely to get you the results you want in the safest and most predictable manner. Call (925) 943-6353 and schedule a personalized consultation appointment, today.
The Thigh Lift was performed about 10,000 times last year in the United States alone. It is a specialized procedure that is almost exclusively performed after weight loss or bariatric surgery. As Thighplasty techniques have improved, its popularity has increased. The number of Thigh Lifts performed is up 8% this year compared to last year and up 87% since the year 2000.
Thigh Lifts are most often performed after massive weight loss or bariatric surgery. They can be combined with other skin tightening procedures, such as an abdominoplasty in this case.
Thighplasty Techniques (Thigh Lift)
There are two main techniques used for the Thigh Lift. For reduction of upper inner thigh skin redundancy an Upper Thigh Lift is performed using an incision that wraps around the upper thigh from the groin, along the top of the thighs and underneath the buttocks. This keeps the scar high on the thigh and allows for maximum upper thigh tightening.
The Medial Thigh Lift uses a scar running down the inside of the thigh from the top to the knee. This scar is more exposed than the scar from an upper thigh lifts; however, it can tighten the skin at the knees better. Which type of lift will work best for you depends on where the skin is loose. The following video discusses more Thigh Lift Details.
Thigh Lift Video (Thighplasty)
Thigh Lift Presentation
The Thigh Lift Video Presentation above is a segment from the San Francisco Bay Area’s News Station, KRON 4’s, Body Beautiful. The show discusses the latest in Cosmetic Plastic Surgery, and the topic for the day was Thigh Lifts. Thighplasty Before and After Pictures are displayed and narrated, to demonstrate how the procedure is performed and the results that can be obtained. Individual results will vary depending on the amount of skin laxity, amount of thigh fat that remains and the elasticity of your skin.
The American Society of Bariatric Plastic Surgeons was formed by Board Certified Plastic Surgeons specializing in skin tightening after massive weight loss.
If you are seeking a Thigh Lift, be certain to discuss your goals with a Board Certified Plastic Surgeon, who is familiar with Postbariatric Plastic Surgery. As an active member of the American Society of Bariatric Plastic Surgeons (ASBPS), post weight loss skin tightening is an area in which I specialize.
If you are in the greater San Francisco Bay Area and would like to schedule a personalized consultation appointment for a Thigh Lift, or another Cosmetic Plastic Surgery procedure, call (925) 943-6353 today.
Breast Augmentation adds volume, while Breast Lifts reshape. What happens when you put them together? You get Cosmetic Plastic Surgery that can enhance both breast volume and shape.
Total Breast Enhancement – Breast Aug and Breast Lift
Sometimes a Breast Implant or a Breast Lift alone is not enough to get the results we want. The combination of Breast Augmentation with a Breast Lift, or Augmentation Mastopexy, is used when breast sagging is combined with a loss of breast volume. Board Certified, San Francisco Bay Area Plastic Surgeon, Dr. Joseph Mele, discusses the nuances of Breast Augmentation Combined With Breast Lift on this episode of Body Beautiful, a live television show dedicated to the latest in Cosmetic Plastic Surgery news for the greater San Francisco Bay Area.
Everyone knows that Breast Implants make breasts bigger. It’s a simple concept. Adding volume behind the breast tissue, often behind the pectoralis muscle, enlarges the breasts you have. While the size of the breast changes, the shape does not. It simply inflates the skin you have.
Breast Lifts Make Breasts Perkier
Breast Lifts (Mastopexies), on the other had, are all about breast shape. Lifts do not make breasts bigger or smaller. Breast Lifts reshape the skin envelope. Mastopexies reposition the nipples/areolae into a more attractive position and reduce the amount of breast tissue that sags below the IMF (inframammary fold).
Breast Augmentation Lift Consultations
The subtleties of the procedures, whether considered separate or together, are beyond the scope of one San Francisco Plastic Surgery Blog post, though you will find other posts on the topic here and on my other web sites. But rather than learning everything there is to know about both, why not learn about the aspects of the procedure that apply to your body?
Breast Augmentation Lift Consultations are the best way, and really the only way, to get the information specific to your needs. They focus on your breasts and your goals. You won’t waste time learning about options that won’t do what you want, and you will learn what to expect from the procedures that are most likely to help you.
If you would like to schedule a personalized and private Breast Enhancement Consultation, call my office today at (925) 943-6353. Get specific information that is tailored to address your needs, not generic information meant for the masses.
Excess arm skin can be uncomfortable both physically and emotionally. The Arm Lift, or Brachioplasty, removes excess skin from the upper arm. This Arm Lift Video Presentation reviews many of the frequently asked questions and illustrates the possible results with expertly narrated Brachioplasty Before and After Pictures . All Arm Lift Before and After photos are actual patients of Dr. Joseph Mele, San Francisco Bay Area Board Certified Plastic Surgeon in Walnut Creek, California.
The above Arm Lift Before and After Photos demonstrate what a Brachioplasty can do. Excess skin is removed, leaving the arm tight, firm and with a more muscular contour.
Arm Lift Video (Brachioplasty)
The Arm Lift Video below is a recent segment from the San Francisco Bay Area’s News Station, KRON 4’s, Body Beautiful. Host Janelle Marie and I discuss the Brachioplasty procedure, including the available options and the recovery period. Arm Lift Before and After Photos are used to show what the procedure can do on real patients.
The usual Arm Lifts incision runs along the inner arm, from the elbow to the armpit (axilla). The placement options are reviewed in the Brachioplasty Video above. If you have a small amount of skin laxity, which is located close to the axilla, a Mini Brachioplasty, with the scar located in the axilla, may be possible. If your arm skin is already firm, and the problem is disproportionate fat, Liposuction alone may be your best option.
The above Arm Lift before and after pictures demonstrate how careful scar placement enhances the results. In this case, the excess skin was removed using an incision that runs from the inside of the elbow to the back of the armpit. Even with the elbow rotated backward, the scar is still hidden along the lower border of the arm.
Arm Lift Consultations (Brachioplasty)
There are several options for Arm Rejuvenation. To find out what your Arm Lifting choices are, call (925) 943-6353 and schedule a private, personalized consultation in our Walnut Creek Plastic Surgery office. If loose arm skin is bothering you, learn what treatments are available from an experienced, Board Certified Plastic Surgeon.
Big Arms are a big deal. I’m not talking about the “big guns” produced by lifting weights. I’m talking about loosing weight, getting in shape and still having big arms due to loose, flabby skin. This is a common problem for anyone who has lost a significant amount of weight. Some people are born with large arms and loose skin, but many of my Arm Lift patients have lost weight through diet and exercise or after bariatric surgery. For them, the larger the weight loss, the bigger the problem.
Arm Lift (Brachioplasty)
Brachioplasty literally means arm changing. The ideal candidate is healthy, with a large amount of loose, redundant upper arm skin. Sometimes called Bat Wings, this skin excess is not amenable to exercise, and further weight loss only exacerbates the problem. There is no skin shrinking ray, so the options are often either an Arm Lift or to live with it.
Arm Lift Video (Brachioplasty)
Below is a recent Body Beautiful segment dedicated to Arm Reduction surgery from the San Francisco Bay Area’s News Station, KRON 4. This Brachioplasty Video answers many of the frequently asked questions about Arm Lifts and reviews the results that some of my patients have received. The information provided is accurate, but cannot be considered medical advice. An in-person consultation with a Board Certified Plastic Surgeon is always recommend prior to choosing a treatment plan.
Arm Lift Before and After Pictures
The above Arm Lift Video includes many Brachioplasty Before and After Pictures. From arm to arm there are differences in appearance, so the Arm Lift is adapted to your unique needs. There is no substitution for an in-person evaluation, but additional Arm Lift Information is available here on the San Francisco Plastic Surgery Blog and on my main web site’s Arm Lift Page.
Arm Lift Consultations
If you want to know more about your options for Arm Reduction, call (925) 943-6353 today and schedule your personalized Arm Lift Consultation. A focused physical examination and medical history are how we start. If you are a candidate, the risks, benefits, procedure, alternatives, limitations and recovery of the Arm Lift are reviewed in detail, so that you can make an informed decision.
Mommy Makeovers are a combination of cosmetic plastic surgery procedures that enhance, or repair, the breasts and belly. Since both areas take a hit with pregnancy, it is most commonly performed for mommies, but Mommy Makeover procedures are also performed after weight loss. Post Bariatric Surgery patients often have loose skin on their breasts, bellies and other areas, so Mommy Makeovers are performed after weight loss also.
The Mommy Makeover helps by enhancing both the breasts and the belly in a single combination plastic surgery procedure. Above, a Breast Augmentation Lift (Augmentation Mastopexy) is combined with a Tummy Tuck for the optimal result.
The Mommy Makeover is a not a specific operation, but rather a combination of breast and belly enhancement procedures. Each area is evaluated separately and we choose one from column A (breast enhancement) and one from column B (belly enhancement) and the combo plate is termed a Mommy Makeover. The ability to mix and match is what makes the procedure so powerful. The best procedures for each area are combined.
Mommy Makeover – Breast Enhancement
Breast Enhancement is half of the Mommy Makeover. In this case, a Breast Augmentation Mastopexy is performed. A Breast Implant is used to increase the breast volume, while a Breast Lift is used to raise the nipple and reshape the breast. A larger implant without a lift would not make a pretty breast. A larger implant would make larger breasts, too large for this patient’s desires. Additionally, the larger implant would push the nipple lower on the breast.
Breast Enhancement includes many options. The most common are Breast Augmentation and Breast Lifts, though for those women whose breasts do not shrink after pregnancy, Breast Reduction is also a possibility. Below is a list of Breast Enhancement procedures with links to additional information:
The gold standard of Belly Enhancement is the Tummy Tuck. It reduces loose abdominal skin, removes excess belly fat and tightens muscle laxity including rectus diastasis (muscle separation).
Belly Enhancement also includes several options. The classic Mommy Makeover is a Breast Augmentation combined with a Tummy Tuck. The Tummy Tuck (Abdominoplasty) is the work horse. Abdominoplasty can correct loose skin, lax muscle fascia and remove excess fat. It is the only procedure that addresses all three areas over the entire belly. Sometimes, a Tummy Tuck is more than is needed so “smaller” procedures, like Mini Tummy Tucks or Even Liposuction can be substituted for selected patients. Links to more information about the Tummy Tightening Procedures are provided below:
Liposuction can also be added to help with other problem areas like the love handles, muffin top, thighs, arms or chin, too.
Mommy Makeover – Putting It All Together
Choice is good, but sometimes too many choices leads to confusion. The beauty is that you don’t have to decide on your own. An Experienced Board Certified Plastic Surgeon is skilled in all your options, and can explain which procedure best accomplishes your goal. This can help you choose the best procedures, and help you know before committing, if a Mommy Makeover is right for you.
Mommy Makeover Consultations
If you are considering a combination of Cosmetic Plastic Surgery like a Mommy Makeover, call (925) 943-6353 today, and schedule a personalized and private consultation. The best breast and belly procedures will be discussed, and a specific plan created just for your body.
Plastic Surgery can help tighten loose skin in many places. Cosmetic Plastic Surgery procedures like the facelift, tummy tucks and breast lifts are well known. These procedures tighten loose skin of the face, tummy and breasts. Loose thigh skin, on the other hand, is less talked about.
What Is A Thigh Lift?
The Thigh Lift is a specialized cosmetic surgery that specifically tightens loose thigh skin. Also know as a thighplasty, the thigh lift can provide the finishing touch after weight loss. This is not a procedure that should be routinely performed for thigh skin that is a little loose. It is meant to remove redundant skin, and works best when the inner thigh skin looks less like a skin suit and more like skin drapery.
Thighplasty Video From Body Beautiful on KRON 4
Last week, I discussed Thigh Lifts on the San Francisco Bay Area’s News Station KRON 4. The show, Body Beautiful, gives me the opportunity to talk about the latest and the greatest procedures and treatments that Cosmetic Plastic Surgery has to offer. This week’s show included a segment on a lesser discussed procedure, the Thigh Lift. The video segment below is included in case you missed the television show.
Thigh Lift Video (Thighplasty)
Who Needs A Thigh Lift?
The Thigh Lift is most often performed after weight loss. Post Bariatric Plastic Surgery is a discipline of Plastic Surgery that specializes in tightening loose skin that is leftover after weight loss. The inner thigh is an area that is often left stretched out and deflated after weight loss. The thigh lift is designed to remove the excess skin and tighten the thigh. If is different than Liposuction, which only removes fat and may further loosen the thigh skin.
How Is A Thigh Lift Performed?
There are two main methods for removing loose thigh skin. One uses an incision that runs from the groin, between the legs at the top of the thigh and ends in the fold under the buttocks. The location of the scar makes it easier to hide. The second method uses a scar that runs down the inner thigh and ends at the knee. This method is better for removing skin on the lower thigh, but the scar is more noticeable. When the lateral thigh it the problem, a lower body lift or lateral thigh lift may be a better choice.
Which Thigh Lift Is Best For Me?
Determining which, if any, method is best requires a consultation with an experienced, Board Certified Plastic Surgeon. A focused medical history, combined with the physical examination can help determine the timing and the type of Thigh Lift that is likely to maximize the benefits and minimize the risks.
If you are considering a Thigh Lift, call (925) 943-6353 today to schedule a private and personalized consultation appointment.
On July 15th, Alameda County Superior Court Judge Wynne S. Carvill tentatively ruled that Kaiser Permanente cannot systematically classify removal of excess skin following bariatric weight loss surgery as a cosmetic procedure, and that Kaiser misinformed patients and doctors by claiming removal of disfiguring excess skin following gastric bypass surgery is not a covered procedure. This may be good news for Bariatric Patients, but the ruling is not final.
It’s a question as old as insurance companies, “Is it cosmetic or reconstructive?”
The class action lawsuit, Wendy Gallimore, et al. v. Kaiser Foundation Health Plan Inc, was heard in the Superior Court of the State of California for the County of Alameda. While the ruling would prohibit Kaiser from arbitrarily denying all bariatric patients access to post bariatric plastic surgery, it would allow Kaiser doctors to decide on a case-by-case basis whether patients qualify for a referral to a plastic surgeon.
According to the Insurance Journal Article, Judge Carvill rejected Kaiser’s argument that excess skin is not a disease, and instead ruled that its policy of only providing referrals to plastic surgeons for patients whose excess skin presented a functional problem stands in contrast with the California Health & Safety Code. The code requires insurance companies to pay for reconstructive surgery to repair disfigurement caused by trauma or disease.
Insurance Companies Are Saving You Money
Insurance companies will claim their behavior is aimed at controlling costs, and I understand that they do not want to cover Cosmetic Surgery. What I don’t understand is why Plastic Surgeons have to prove each procedure is not “cosmetic.” More than half the procedures that Plastic Surgeons perform are reconstructive.
How Breast Reconstruction Became “Reconstructive”
There was a time in the not distant past, when insurance companies considered reconstructive breast surgery after a mastectomy for breast cancer Cosmetic Surgery. The insurance companies claimed that since the cancer was removed, there was no immediate threat to a woman’s health, so reconstructing the breast was unnecessary, and that breast reconstruction provided only a cosmetic result. While it is true that a woman can live without her breast, and that a minority of women choose not to have breast reconstruction after a mastectomy, it is equally true that most women do not feel whole until after breast reconstruction is performed.
While some states acted on behalf of their female residents, not all did. Through massive lobbying efforts, including patients, doctors and professional societies like the American Society of Plastic Surgeons, the Federal Government was compelled to act. The choice to have insurance coverage for breast reconstruction was not ensured, or insured, until the Women’s Health and Cancer Rights Act was signed into law on October 21, 1998.
The Women’s Health and Cancer Rights Act of 1998
The law known as Janet’s Law was championed by Republican Senator Alphonse D’Amato from New York, and our own San Francisco, California, Democratic Senator Dianne Feinstein, and twenty-one other US Senators in a truly bipartisan effort.
Janet’s Law is named after a 32 year-old Long Island woman, Janet Franquet, who was diagnosed with an aggressive form of breast cancer in late 1997. She required chemotherapy to try to shrink her tumor, followed by a mastectomy. A young woman, she desired reconstructive surgery to restore her amputated breast. Her Plastic Surgeon, Dr. Todd Wider, contacted her insurance company for permission to reconstruct her breast. Janet’s insurance plan refused to cover the reconstructive surgery, and considered it cosmetic. The carrier recommended using a skin graft if the wound could not be closed primarily. Dr. Wider, disgusted by the insurance plan’s idea of medical care, performed the breast reconstruction for free. When insurance companies claim they do not make medical decisions, think about Janet’s plight. If not for the generosity of a Plastic Surgeon, her breast would remain flat, or more likely indented with a skin graft.
Dr. Wider did more than give away his skills, he contacted his federal representatives and went to bat for all patients. Senator D’Amato said the following to then US President Bill Clinton from the floor of congress when he had heard that the insurance carrier had denied Ms. Franquet coverage for her surgery:
“Mr. President, I decided that I would give Mrs. Franquet’s insurance company a call. When I spoke with the Medical Director, he told me that “replacement of a breast is not medically necessary. This is not a bodily function and therefore cannot and should not be replaced” … Luckily for her, Dr. Todd Wider agreed to forgo payment of this surgery. … I ask you, Mr. President, how many other Janet Franquets are out there? Will they be lucky enough to have a Dr. Wider to take care of them? … Too many women have been denied reconstructive surgery because insurers have deemed the procedure cosmetic and not medically necessary. It is absolutely wrong.”
Problem (Not) Solved
In case you think the problem is solved, I assure you it is not. This week, I corresponded with a local insurance plan that promises you will “Be Heard.” Despite multiple interactions with the insurance plan by my staff and myself, including writing two letters, sending pictures, twice, speaking with the nurse reviewer, speaking with a physician reviewer, I was told almost exactly the same line that Senator D’Amato was told almost 20 years ago. My patient’s breast reconstruction did not not pose an eminent health risk and reconstruction would be denied. Perhaps he has forgotten, The California Health & Safety Code requires insurance companies to pay for reconstructive surgery to repair disfigurement caused by trauma or disease. Do we need a specific law for every diagnosis?
We do have the right to appeal, but no new information will be necessary, and all of us, my patient, her family, my staff and myself have to spend more time away from our otherwise productive lives trying to get the insurance plan to do the right thing. The only difference is my patient does not have breast cancer, she was born with a severe form of tubular breast deformity. Fortunately, she is a very strong, very mature young woman, and even though she was not even born when Mrs. Franquet’s Insurance Company’s Medical Director proclaimed “replacement of a breast is not medically necessary,” she must again fight the same battle.
Keep The Faith
Without the legislative process, there would be no coverage for breast reconstruction. When Insurance plans can’t justify their actions medically, they simply stop providing coverage. A good example is Breast Reduction. Breast Reduction relieves chronic neck and back pain, among other symptoms. There is overwhelming clinical evidence of the benefits, so now that they can no longer decline the benefit of the procedure, insurance companies are excluding Breast Reduction from their coverage. Check your policy and see if you are covered or excluded. Will we need another law to keep coverage for Breast Reduction when medically indicated?
I look for the good in people, but I’ll admit, I was very disappointed with my patient’s insurance company, especially after spending so much time and effort informing multiple reviewers of the situation. Their decision is troubling, but I suppose made easier by not having to see my patient and realize she is a real person who has a real promising life ahead of her.
On the other hand, Alameda County Superior Court Judge Wynne S. Carvill’s ruling gives me hope. The goal of medicine is enhance our population. By relieving physical pain with Breast Reductions or emotional pain with Breast Reconstruction, Plastic Surgeons improve the quality of our patients’ lives. This is not just true for the patient, but for their family, friends and co-workers. Happier patients are nicer to those around them and more productive citizens. The reconstructive vs. cosmetic arguments will continue; however, if more productive citizens get involved, more reconstructive surgeries can remain reconstructive.