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Jumping Through Hoops: Surgery & Insurance

After years of thinking about receiving a breast reduction surgery, it was hard to know where to start. But after gaining an even larger chest thanks to quarantine and learning that it IS possible to get a top surgery during Covid times when a friend of mine received one in the summer of 2020, I was more resolved than ever to bite the bullet and get the ball rolling for a breast reduction surgery in 2020.

So what did it take?

Living in the United States of America, it is often wise to start decisions about where to go for health services by verifying what places and/or practitioners are covered under your specific insurance plan. So I started by calling my insurance company and asking which plastic surgeons in the Fargo/Moorhead (FM) area would be covered under my family's insurance plan. The insurance company gave me a list of 8-10 different plastic surgeons in the FM area, as well as the address and number where they work. I called one of the surgeons on the list and the receptionist dryly informed me that I needed a referral from a general practitioner in order to even get a consult from a plastic surgeon. 


You mean to tell me, I couldn't meet with a plastic surgeon until I met with a general practitioner?

Eeeup. And to make matters worse, I did not even have a general practitioner (GP) in the area. I mean, what college post-grad in America actually does a check up every year, let alone with the same general practitioner? So I had to find one. I ended up going through Sanford. I was able to get an appointment with the GP within one week's time with a person I had never met before; we met via Zoom. 

This is a rough sketch of how the conversation with said GP went:

GP: What can I see you for today?
Me: I need a referral for a breast reduction surgery.
GP: Alright, who do you want to go through? We have X plastic surgeon here at Sanford.
Me: Yup, looks like that surgeon is covered under my plan.
GP: Alright, looks like they can get you in on Thursday (two days from then).
Me: That works.

The whole conversation took less than 10 minutes. The GP did not ask me about my chest size, why I wanted the surgery, if there were any limiting factors that would make it impossible for me to get the surgery, and when I asked if she needed to know any of that information, she told me that all of that information would be covered with the surgeon. 

That appointment, which without insurance would easily cost over $100, consisted only of me being redirected to another individual who, in theory, I could have just contacted myself. Such is the money-grabbing nature of the American health care insurance system. Just another hoop to jump through.

Two days later,

I met with my plastic surgeon, Pamela M. Antoniuk, MD, in person, two days after the conversation with my GP. Dr. Antoniuk gave me all the information I would need to know about what a breast reduction could look like for me. She told me there is always a possibility, though remarkably small, that the following could happen:

  • infection
  • loss of sensitivity
  • increase in sensitivity 
  • inability to lactate/breastfeed after childbirth
  • lack of blood flow to the nipple could, in extreme cases, cause the nipple to turn black and fall off
Some of these side-effects, such as change in sensitivity, are common, others, not so much. I am certain there were more complications that could occur, but I cannot recall them off the top of my head. None of this phased me. I was largely aware of all of these possibilities prior to my consult with Dr. Antoniuk. I didn't care if my nipple fell off or I could not breast feed. I wanted a smaller chest. I wanted to go shopping for bras at regular places like Victoria's Secret and Walmart. I wanted to see my waist and take a load off my chest. I wanted less back and shoulder pain. I wanted a breast reduction, come hell or high water. 

"If you could go to any size you want, what size would you go to?" Dr. Antoniuk asked me.

Her question excited me. To choose my own cup size? I felt like I was in a dream. "I want them as small as possible. I would prefer a B or a C [cup], but would be fine even with an A [cup size]," I informed her.

"I am going to be honest," Antoniuk said frankly, "with breasts your size, I don't think I will be able to safely go below, maybe, a D or a C [cup size]." She went on to explain that the reason for this is because going smaller could compromise the surgeon's ability to allow blood to flow properly to the nipple and back, therefore compromising the safety of the breast and person as a whole. 

It upset me a little bit to know that I could not go as small as I wanted, but I was still as resolved as ever to have a smaller chest.

The appointment ended with Dr. Antoniuk taking photos of my breasts for medical purposes. She assured me that she would be surprised if insurance did not cover my breast reduction. I put my shirt back on and Dr. Antoniuk's looked at my chest a final time before leaving the room, "Oh yes. You DEFINITELY need a breast reduction," she affirmed.

I had to wait about three weeks after that appointment for insurance to approve me for the surgery and for me to schedule the surgery itself. I could not schedule the surgery until insurance approved (or disapproved) it. Insurance approved my surgery at the end of August. I ended up scheduling the surgery for the soonest available time, about one month out on October 5th, 2020. 

 

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