Wednesday, December 2, 2009
PUTTING IT ALL TOGETHER: The Socially Constructed Breast: breast implants and the medical construction of need
Sunday, November 22, 2009
Health Insurance Coverage for Reconstruction Following Mastectomy
Women have right to health insurance coverage for breast reconstruction surgery after mastectomy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
By Insure.com Last updated May 22, 2009 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Health Insurance Options for Breast Augmentation
INPRACTICE
Is It Covered?
by Patricia McGuire, MD
It is time to get educated about insurance reimbursements for breast procedures
I think that it is necessary for an individual insurance company to cover breast augmentation following a mastectomy or for any other medical reason for breast augmentation. For these purposes I see it in the same light as any other prosthetic. One would not deny someone who needed a prosthetic hand due to amputation from cancer or otherwise, so why should a breast be any different. In this article they do not focus on breast reduction at all. In my opinion that form of breast reconstruction should also be covered when done for medical reasons i.e. back problems. On the other hand, I do agree with some insurance companies that "[t]he insurance company's stand is that if the patient chooses to pay for aesthetic breast augmentation, all costs related to the surgery are the patient's responsibility." If the procedure is purely cosmetic the patient is fully aware of the risk and future costs, and it is completely elective. If cosmetic breast reconstruction coverage begins where will the line on coverage be drawn? That being said, if the patient has a defective implant, leak or an unsuccessful surgery I believe the cost should be place on either the surgeon or the supplier of the implants to ensure quality.
Government Funding for Breast Reconstruction?
$2.95 Million Government Breast Reconstruction Funding Gives New Benefit To Breast Cancer Survivors, Australia
Main Category: Breast Cancer
Article Date: 30 Oct 2009 - 1:00 PDT
It appears someone in the Australian government understands what a mastectomy really means to the woman undergoing the procedure. As if months of sickness, hair loss and in having to accept that you may not survive are not hard enough on a female breast cancer victim, often she must suffer the loss of one or even both breasts. For those of us who still have ours it probably seems like a small price to pay for survival. But our breasts are more than just fatty tissue and glands. They represents femininity and beauty.Women with a smaller set often feel insecure about their body, but it can't be worse than the feeling of having yours taken away from you. No different than our hands, breasts are part of who we are.As long as the Australian governement restricts the funding to masectomy recipients there's only good being done by the program.
We found this article really interesting because of the information it provided us regarding a truly innovate biotechnology: a customized biodegradable chamber contoured to match a women’s natural breast shape. What is even more remarkable is that this technology can foster the growth of the permanent fat that is found in breasts. The article also mentions that if there is insufficient fat following the mastectomy that researches intend to develop a muscle tissue that induces fat tissue production called Myogel. These new biotechnologies will enable patients to seek alternatives to silicon implants for their reconstructive breast surgery. The work of these Australian researchers is admirable and their dedication to the cause is something that should definitely be mirrored by researchers in other countries. We feel as though the results in patients that receive breast reconstruction with materials that are the most similar to those found in the human body will be revolutionary and very beneficial to their overall well being and assurance. It is also very promising to see government funding being used for the development of essential biotechnology such as a biodegradable chamber and other essential devices as mentioned in the article.
Friday, November 20, 2009
Celebrity Obsession with Breast Augmentation
Why do stars love boob jobs?
By BELLA BATTLE
Published: 08 Oct 2007
There are countless articles such as this one that detail celebrities’ obsession with breast augmentation and more general cosmetic surgical procedures. Although it is unfortunate that so many stories exist concerning celebrities’ addiction to plastic surgery, the articles provide extensive information about why some people are more likely to suffer from such a costly and body altering addiction. Essentially, this article is intended to open doors to further research surrounding why celebrities with so much disposable income chose to spend their hard-earned money on seemingly unnecessary and risky surgical procedures. According to this article, many celebrities feel as though they need to undergo breast augmentation surgery in order to feel as though they are deserving of such high profile attention. Since they are constantly in the spotlight, the article suggests that they begin to feel like commodities. In this sense, celebrities must ultimately sell themselves to the public in order to continue to advance in their careers. Truth is, there are plenty of very successful celebrities that have avoided cosmetic breast implantation and the public scrutiny that subsequently follows such dramatic procedures. The question that pervades is why do some celebrities feel they need to undergo such procedures when others can continue on a successful path without the aid of breast augmentation. Current research suggests that some people are simply predisposed to surgical procedures as a way to improve the way they perceive their body and ultimately themselves. Many celebrities suffer from body dysmorphic disorder in which they become dissatisfied and eventually obsessed with a certain body part that they feel is inadequate. This can certainly explain the growing rates of breast augmentation surgery amongst young celebrity women. As a result of the constant attention and commentary on their body types, many female celebrities feel as though breast augmentation is a quick fix to all of their problems and since they can afford the procedure it is much more attainable.
Thursday, November 19, 2009
Essential Questions Regarding Breast Augmentation
Questions to ask your Breast Augmentation Surgeon
American Society of Plastic Surgeons
All Materials 2009 ASPS/PSEF
- It is important to be an active participant in the process, so we've developed the following
- list of questions to ask about breast augmentation during your consultation:
- Are you certified by the American Board of Plastic Surgery?
- Were you trained specifically in the field of plastic surgery?
- How many years of plastic surgery training have you had?
- Do you have hospital privileges to perform this procedure?
- Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
- Am I a good candidate for breast enhancement or breast enlargement?
- What will be expected of me to get the best results?
- Where and how will you perform my breast augmentation surgery?
- What shape, size, surface texturing, incision site and placement site are recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How many additional implant-related operations can I expect over my lifetime?
- How will my ability to breastfeed be affected?
- How can I expect my implanted breasts to look over time?
- What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
- How will my breasts look if I choose to have the implants removed in the future without replacement?
- Do you have breast augmentation before-and-after photos I can look at for this procedure and what results are reasonable for me?
- If so, at which hospitals?
- How are complications handled?
- After pregnancy? After breastfeeding?
Regarding the American Society of Plastic Surgeons list of suggested questions, the first 7 questions are kind unnerving. The idea that when looking into breast augmentation you need to ask those kind of questions regarding the ability of the surgeon really makes one wonder about the safety and efficacy of this kind of surgery. It also leads to the question about how prevalent the black market or unlicensed undertaking of this procedure is. As well as how easy it is to find yourself in that situation without even knowing about it. A lot of the other questions on the list would be very helpful if considering breast augmentation. The particularly necessary and I think under recognized ones are those regarding post surgery necessities and issues regarding unwanted results. That would be very helpful in the decision process.
http://www.feminizationsurgery.com/services/breast_augment.htm
Ask Dr. Beck
Feminization Surgery
© 2008 Bay Area Aesthetic Surgery. All Rights Reserved
Q:I have heard that people’s implants get hard over time. Is that true?
A:You are referring to a condition called “capsular contracture.” This is a contraction of the natural internal scar tissue that surrounds the implant. It is a small risk, but one that must be considered. Should capsular contracture occur and bring discomfort or distortion to the breast(s), a surgical procedure can be performed to correct the situation. In rare cases, the implants must be replaced or removed altogether. Saline implants have a lower incidence of capsular contracture. Following pre and post operative instructions can also help reduce your risk.
Q:What is the link between autoimmune diseases, cancer and breast implants?
A:Despite all the publicity, the “FDA Breast Implant Consumer Handbook 2004” dispels any possible links between illness and silicone or saline implants.
Q:Will a breast implant lift my breasts up?
A:An implant will expand the size and alter the shape of a breast. The shape of some implants can mediate mild breast sag, but will not change the position of the nipple or counteract significant droop.
Q:Can I choose if I want my implant above or below the muscle?
A:Not always. It depends on your anatomy and options should be discussed with Dr. Beck or Dr. Brink.
Q:Are there any guarantees that my implant won’t break or leak?
A:There are no guarantees, but there are warranties available. Implants are engineered to withstand considerable pressure or impact; however they are not lifetime devices. Following your procedure we will give you a serial number and warranty card from the implant manufacturer. You can elect to purchase an extended warranty.
The Q and A from "Dr Beck" would be very helpful. Upon researching this topic, finding the answers to frequently ask questions was relatively scarce. This is likely due to the highly individual nature and motivations for the surgery. I found it very interesting to see a doctor’s answers to frequent patient concerns. I would have also liked to have seen some answers from an objective researcher as I got the impression that this information was being given by a plastic surgeon with somewhat of a biased perspective.
Monday, November 16, 2009
National Cancer Institute's Study of Breast Implant Risk
Breast Implant Study
In March 2000, the National Cancer Institute (NCI) published their findings from a study conducted in response to the FDA's 1992 ban of silicone gel implants.The study included 13,500 participants who had surgery for cosmetic implants in both breasts before 1989. And for comparison, the study looked at 4,000 other patients similar in age who had other types of cosmetic surgery. The study was based of collected medical records or death certificates (no examinations were performed on the participants by the NCI). About 80% of participants were successfully tracked, and 70% of those provided updated information.It is one of the longest studies into the relationship between breast augmentation and cancer development. Additionally, no other study has taken into account patient lifestyles or compared its findings with other cosmetic surgery recipients. Additionally, the study distinguishes between the affects of silicone and saline breast implants.The NCI found that there is no risk correlation between breast implants and the subsequent development of breast cancer. Breast cancer risk was also not associated with any certain type of implant. There was also no significant difference in breast cancer mortality between the implant and comparison patients.
Saturday, November 14, 2009
Racial/Cultural Determinants of Breast Reconstruction (2)
This segment from Women's Health on MentalHelp.net provides a recent study published in the 'Journal of Clinical Oncology' that show a cultural discrepancy. It was found that Latinas that retained their original cultural beliefs were significantly less likely to opt for breast reconstruction than Caucasians as well as lees likely to talk to a plastic surgeon before their mastectomy. However they are more likely to seek out more information about the procedure. This proves to be an interesting study in why a cultural group would be want to be the most informed about breast reconstruction and remain the least likely to have the procedure preformed.
http://breastcanceraware.net/2009/10/breast-reconstruction-varies-by-race.html
The second link we posted is a more intensive review of the same study in the 'Journal of Oncology'. This review provides a list of all categories of women studies, the percentages of all categories that received reconstruction. It also included a quote from the lead study author. She commented on reconstruction as an improvement on quality of life. This review also better explains the results by stating that less-accultured Latinas reported that their surgeon did not explain reconstruction and were less likely to be referred to a plastic surgeon, but they would have liked to receive the information. Through the results the study suggests that better efforts be made to present reconstruction as an option for all patients. The comparisons of these two site reviews shows that even when discussing the same study information can still be better conveyed by some sites than others. Some information can be confusing and incorrect inferences can be made from that information.
Socioeconomic Determinants of Breast Reconstruction
The article demonstrates a general correlation between socioeconimc status and the decision to undergo breast reconstruction post. Women who are less educated (high school diploma or less) showed a significant less percentage in reconstruction. Additionally, minority groups and patients who were unemployed showed a low percentage in the choice to undergo reconstruction.
The numbers show that reconstructive surgery is more a luxury for the elite. Femininity is often associated with the female breast, which begs the question: Should all women who undergo masectomy have the right to reconstruction? It seems unfair that surgery that can have such an impact on a woman's emotional state and quality of life should in fact be an achievable technology. In order to tip this scale, either governement funds or insurance need to begin absorbing some of the cost. Women should have the right to choose.
Friday, November 13, 2009
Types of Surgery- Incision types and Basic Procedures
What better way to learn about breast implants than to research the procedure as if you are going to have it? We stumbled upon this website which is meant to inform prospective breast augmentation patients about their options. There are many different sites that give similar information but this one was one of the easier ones to find as well as to follow. This page offers simple explanations of current placement types and incision types. There is even more information that is easily accessed through the links on either side of the article.
Breast augmentation has become a very personalized procedure with many different options that can suit the different needs of different patients. For example, there are many different sizes of implants as well as different shapes. There are also different procedures offering more or less recovery time, more or less accessibility to the implant and even a choice of how natural the patient wants the breast implant to look and feel. Most importantly this website has links that give a good review of the major risk factors involved in breast augmentation surgeries. The information presented in this site is very helpful for patients who just want a general understanding of the pros and cons of different types of breast augmentation and is a testament to the most current advancements in medical technology within the field of cosmetic surgery.
Monday, November 9, 2009
Types of Breast Reconstruction Following Mastectomy
This link provides information for someone seeking information about post-mastectomy breast reconstruction. It goes over what breast reconstruction is, why one might choose to have it and what it entails in simple, easy to understand language. It discusses the difference between immediate reconstruction (directly following the mastectomy) and delayed reconstruction (following father chest radiation or other delay factors) and flap gives personal factors that would weigh in on ones decision. It also provides a list of other considerations for this type of procedure. It gives a detailed description of two types of reconstruction; implant procedures and tissue flap procedures. There is also optional nipple and areola reconstruction for aesthetic purposes. They provide a helpful list of questions to ask your physician and well as a list of pros, cons and possible risks regarding the reconstruction. They talk about the pre and post reconstruction issues. It is nice see that the website states that this procedure may boost self-esteem and self-image but it also may not. Some people may not be satisfied with their reconstructed breasts.
http://www.clarian.org/ADAM/doc/HealthIllustratedEncyclopedia/3/100156.htm
The link above provides a simplified step by step procedure of post-mastectomy breast reconstruction. Detailed images are provided to take the reader through a guided description of one type of procedure.
Reasons for Cosmetic Surgery
"Breast augmentation plastic surgery is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed, or because of differences in the sizes of the breasts or from changes after pregnancy or breast feeding. Some women may be happy with their breasts but just want them made fuller. Often after weight loss, aging or childbirth a woman's breast volume and shape may change. This too can lead to a woman to seek a breast augmentation. Breast implant surgery performed by cosmetic plastic surgeons is the most popular way to improve breast shape and size. Breast enhancement using breast implants can give a woman more proportional shape and may improve self esteem."
This article on Breast Augmentation from The American Society for Aesthetic Plastic Surgery walks through the basics of candidacy, what to expect with the surgery, potential benefits and risk factors. Written as a purely informative piece, it begins by describing reasons that women seek breast implantation. These include masectomy, changes after pregnancy, or simply dissatisfaction with their natural breasts. The article preps readers with the basic knowledge of what to expect before, during and after surgery. It describes a timeline of the healing process, including figures like how many days it will be before you can shower or do normal activity. They also discuss the benefits of a saline implant (smaller incision, adjustible size and no toxic risk) vs. those of silicone (more structured). The overall message conveyed in the article is that anyone seriously considering breast augmentation should be fully aware of both the benefits and risks associated with the surgery.
Breast Augmentation Video Demonstration
Dr. Loftus Performs and Narrates a breast augmentation surgery and demonstrates both saline and silicone breast implantation
As we continue our research and learn about the basics of breast augmentation we felt that the best way to really understand the procedure and the risks associated with it is to watch a real live surgery. This surgery shows one of the most common of breast augmentation procedures and shows both types of implant (saline and silicone) inserted into the chest underneath the pectoral muscle using an inframammary incision. Most surgeries in the U.S. are of this type where the patient is unhappy with the size and/or shape of their breasts and wants to surgically enhance them to fit their own personal perception of beauty. This video is a quick ten minute look into the procedure, showing basic technique and execution of a routine breast augmentation.
We as a group see ourselves as general medical technology enthusiasts and while we are by no means avid surgery watchers we were impressed to see how this procedure has evolved to become relatively simple as well as minimally invasive. Although the idea of having someone create a pocket inside a person’s chest with nothing more than their forefinger is a bit odd, maybe even a little unsettling for more squeamish viewers, the ease with which the surgeon carries out the procedure shows that when done correctly there should be very little risk for complications. Prospective patients should see that the expertise of the surgeon is a very important factor while researching their options particularly in this type of surgery seeing as it is pretty much always an elective surgery. It is also impressive to note the techniques for minimal scarring that are employed in the video. Medical advancements have made this type of procedure very low risk and in time technique and technology only stand to get better creating even less recovery time and even better results.
Sunday, November 8, 2009
Patient Characteristics
Depression Disorder & Body Image
Women With Breast Implants More Likely to Commit Suicide
"In July of 2007, Sarwer et al. published a review article in The American Journal of Psychiatry investigating recent research linking breast augmentation and suicide. The studies revealed that the suicide rate of women who recieved cosmetic breast implants is approximately twice the expected rate based on estimates of the general population."
Several studies have been published concerning the disproportionate relationship between cosmetic surgery, specifically breast augmentation, and increased suicide rates among postoperative patients. In July of 2007, Sarwer et al. published a detailed review in The American Journal of Psychiatry, which revealed that women who received cosmetic breast implants were twice as likely to commit suicide when compared to the general population.
In choosing this article, which focuses specifically on cosmetic breast implantation, our group hopes to investigate the patient characteristics that predispose these patients to increased rates of suicide. The article describes this correlation in terms of specific patient qualities, motivations and expectations of patients who seek breast implants as a way of improving their social interaction and the way they feel about their bodies post surgery. When these expectations are not necessarily fulfilled, psychopathology results. Characteristics in prospective patients include more frequent alcohol and tobacco use, more sexual partners, higher use of oral contraceptives, having an abortion, eating disorders, and previous psychiatric hospitalizations. The highest risk factors are identified as having been hospitalized, alcohol consumption and tobacco use, and eating disorders.
The article references a study performed by Sarwer in 2004 that seems contradict many other studies that have been performed. Although this researcher found that patients report dissatisfaction with their body image, the studies mention that this dissatisfaction improves postoperatively. No actual statistics are provided which leads us to believe that the studies could be invalid, especially because the article goes on to mention a study by Cerand in 2005 which states that 90% of patients experienced either no change of a worsening of body dysmorphic disorder following breast augmentation surgery. A supporting study by Honigman in 2004 notes that there is no evidence that patients’ interpersonal relationships improve after surgery and that these unrealistic expectations and motivations are associated with poor postoperative outcomes.
It seems logical to think that postoperative dissatisfaction can potentially lead to depression, a disorder that is correlated with increased rates of suicide. Since these patients already exhibit suicidal risk factors prior to surgery, it appears as though many of these studies are logical. When we consider the unrealistic expectations, high cost of breast augmentation surgery and subsequent dissatisfaction with the procedure, it seems very realistic that emotionally unstable patients will exhibit higher suicide ideation rates.
It is interesting when we connect the facts and figures of this article within the realm of the pharmaceutical industry, specifically the market for antidepressants. Women are two times more likely than men to experience depression and it is estimated that nearly 7 million women suffer from some form of diagnosable depression in the United States. When you consider that number of these patients that are on antidepressant drugs, you can imagine the amount of revenue the pharmaceutical industry is generating. According to an analysis of the antidepressant drug market,
http://www.wikinvest.com/concept/Antidepressant_Drug_Market,
the market reached sales of nearly 11 billion dollars in 2008. When we consider the side effects that result from such a high consumption of these synthetic drugs it sheds light on to how multidimensional and complex this problem truly is.
Read more: http://suicide.suite101.com/article.cfm/depression_and_body_image#ixzz0X2mpvGP8
History of Breast Augmentation
To begin our research we all agreed that the first logical step was to research the history of breast augmentation. This article is a very brief history of the procedure and the current techniques that are being used today. As with any procedure, the beginning consisted of a lot of trial and error. Breast augmentation started as far back as 1895 but the results were shaky at best, often resulting in awful scarring or a complete mastectomy. As time went on and technology advanced, the procedure evolved to become much safer as well as more desirable due to the high potential for aesthetically pleasing results. New materials were developed as well as new techniques offering more opportunity for patients to personalize their results particularly regarding size, placement and incision type. Currently, breast augmentation is one of the most popular cosmetic surgery procedures performed in the United States and with the increasing efficiency and efficacy of medical techniques this procedure only stands to gain more popularity as well as more profitability.
We also found it interesting that this article focused specifically on the history of cosmetic breast implantation and breast augmentation which dates farther back than breast reconstruction. We searched extensively for an article pertaining to the history of breast reconstruction options following a mastectomy for research purposes and encountered this article which dates reconstruction back to the late 1970s. In the late 1970s, the latissimus flap was the most popular form of autogenous tissue breast reconstruction. Superior gluteal free flap surgery was performed by Fujino in 1976. In 1978, LeQuang performed the first breast reconstruction with an inferior gluteal free flap.
http://emedicine.medscape.com/article/1274236-overview
Although reconstruction with prosthetic implants remains the most common method of breast reconstruction today, proponents of autogenous reconstruction argue that the natural "feel" and durability of a flap exceeds that of an implant.