breast augmentation, breast cancer, BRCA blood test, and insurance???

[reignofterror]

i feel like i have done so much research on breast augmentation surgery that i've already HAD it done! i am about 98% sure that this is the right thing for me to do, but i have so many misgivings and questions when it comes to breast cancer.

my mother had breast cancer [had 5 biopsy surgeries over 15 years, 4 were benign but the last time there were actual cancer cells, but they got them all! GO MOM!], and her mother had breast cancer after the age of 70 resulting in a mastectomy.

therefore . . this is obviously a concern. i don't want to do anything that would put me in an adverse position for early detection if this does develop, but dammit, i WANT BOOBS. if cancer does develop, what kinds of treatment are safe with implants? the statistics show that 1 in 8 women will develop breast cancer at some point. i mean, that is just ridiculous. have any of you had any post-breast augmentation scares with this kind of thing?

i am considering having the BRCA gene blood test done as a precautionary measure. for those who don't know, research indicates that certain mutations on the BRCA genes mean a 60% greater chance of developing breast and/or ovarian cancer and there is a blood test that can determine if you carry the altered gene. but i'm concerned if i DO have the mutation that i will be discriminated against as far as insurance goes - i'm self-employed and have to seek out my own insurance. does anyone out there have experience with this?

so here i am. one part of me thinks of everything above and is cautious and worried. another part of me says, "well you know what, whatever is going to happen is going to happen". i could get hit by a bus tomorrow and die knowing that the one thing i wanted to change about my body was my breast size and i could've done it but didn't. life is short . . carpe diem . . that kind of thing.

i am a walking contradiction.

any words of advice and/or encouragement and/or logic are most welcome.

thank you for sticking with me through the babble.

[JCsMomma]

This is just my $.02 and what I would do if I were in your position. I don't mean to discourage you at all from getting a breast augmentation, but with such a strong history of breast cancer I would be very cautious. I used to be a MA at a breast center where I assisted with ultrasound guided needle biopsies. We also did routine and diagnostic mammogram, as well as breast ultrasound. It is very true that implants can make performing a mammogram harder, as well as it can be harder for the radiologist to read. The implant can obscure things on the image, which could result in suspicious lesions being missed, or you having to have unnecessary biopsies because the doc can't distinquish clearly enough what the lesion is. I do think that getting the BRCA test would be a good idea as far as being aware and early intervention, but I have no answers about the health insurance deal. Sorry. But also something to think about, that while a negative test would surely offer a lot of peace of mind, it really isn't assurance that you will never get breast cancer. My MIL is a mammographer (we used to work together at the same office), and I am not telling her of my plans for a breast augmentation. I know too well how she, and others in the field, feel about implants and I do not want the negativity. I have no family history of breast cancer so I feel okay with the possible risks. But if I did have a strong personal history, I honestly doubt I would have the breast augmentation. Again, not trying to discourage you at all but just offering my personal opinion. Good luck in whatever you decide.

[jlynn]

I don’t know if this helps or not but I recently had reconstruction done with an implant after having a partial mastectomy. The decision to have the mastectomy wasn’t because the mass was cancerous but rather because the size was a big concern to the doctor. However, the topic of detecting cancer in the future definitely came up.

The PS said that it doesn’t really make it too much harder to detect—just that more precaution would have to be taken and that an ultrasound might be used in addition to a mammogram. In fact he said it’d probably be easier on the side I had the mastectomy on since I have less tissue now. He also just recommended to start getting yearly mammograms earlier than usually recommended. Of course, this is different than what JCsMomma said but it’s what I was told.

I don’t know about insurance covering a breast augmentation alone. In my case, I didn’t have an issue with my insurance covering the plastic surgery reconstruction because apparently it’s a law or something that if the mastectomy is covered, reconstruction must be as well (although I can’t remember who told me this or whether it varies by state).

There are always worries and risks when it comes to any type of surgery. Nothing can be 100% a sure thing. You’re right that you can’t predict the future but it’s definitely a decision that requires a lot of thought. Sounds like you already know what you want to do and have done the research. Have you spoken to any medical professionals in person about it?

[reignofterror]

Originally Posted by jlynn

I don’t know if this helps or not but I recently had reconstruction done with an implant after having a partial mastectomy. The decision to have the mastectomy wasn’t because the mass was cancerous but rather because the size was a big concern to the doctor. However, the topic of detecting cancer in the future definitely came up.

The PS said that it doesn’t really make it too much harder to detect—just that more precaution would have to be taken and that an ultrasound might be used in addition to a mammogram. In fact he said it’d probably be easier on the side I had the mastectomy on since I have less tissue now. He also just recommended to start getting yearly mammograms earlier than usually recommended. Of course, this is different than what JCsMomma said but it’s what I was told.

I don’t know about insurance covering a breast augmentation alone. In my case, I didn’t have an issue with my insurance covering the plastic surgery reconstruction because apparently it’s a law or something that if the mastectomy is covered, reconstruction must be as well (although I can’t remember who told me this or whether it varies by state).

There are always worries and risks when it comes to any type of surgery. Nothing can be 100% a sure thing. You’re right that you can’t predict the future but it’s definitely a decision that requires a lot of thought. Sounds like you already know what you want to do and have done the research. Have you spoken to any medical professionals in person about it?

thank you for this reply! i have not spoken to anyone yet about this, since it is only recently that i decided that i really wanted to pursue the breast augmentation. i have been informing my doctors all along of my family history with breast cancer and they have all said the same thing, "hmm, then we will want to start mammograms on you earlier". i wonder how much extra the ultrasound would be on top of the mammo cost?

and yes, you are right, nothing is 100% sure thing. which goes for the BRCA gene test as well. i've read that if you do have the gene mutation that some people start medication therapy [anti-cancer meds], which seems like a lost cause to me and something i wouldn't want to do anyway. i don't want to be on any medication that isn't absolutely necessary. so i guess even finding out that i do carry the altered gene wouldn't change any path i would take as far as early detection goes - i will still be starting mammo's early regardless.

lots to think about. thank you again!

[reignofterror]

Originally Posted by JCsMomma

This is just my $.02 and what I would do if I were in your position. I don't mean to discourage you at all from getting a breast augmentation, but with such a strong history of breast cancer I would be very cautious. I used to be a MA at a breast center where I assisted with ultrasound guided needle biopsies. We also did routine and diagnostic mammogram, as well as breast ultrasound. It is very true that implants can make performing a mammogram harder, as well as it can be harder for the radiologist to read. The implant can obscure things on the image, which could result in suspicious lesions being missed, or you having to have unnecessary biopsies because the doc can't distinquish clearly enough what the lesion is. I do think that getting the BRCA test would be a good idea as far as being aware and early intervention, but I have no answers about the health insurance deal. Sorry. But also something to think about, that while a negative test would surely offer a lot of peace of mind, it really isn't assurance that you will never get breast cancer. My MIL is a mammographer (we used to work together at the same office), and I am not telling her of my plans for a breast augmentation. I know too well how she, and others in the field, feel about implants and I do not want the negativity. I have no family history of breast cancer so I feel okay with the possible risks. But if I did have a strong personal history, I honestly doubt I would have the breast augmentation. Again, not trying to discourage you at all but just offering my personal opinion. Good luck in whatever you decide.

thank you, JCsMomma . . can needle biopsies be performed with under-the-muscle implants? is there a big fear of puncturing the implant in this scenario?

i am questioning whether the BRCA test would even be beneficial to me at this point. from what i've read, there isn't much different as far as a course of treatment/prevention if you find that you do carry the altered genes - i would not voluntarily start anti-cancer med therapy, nor would i seriously consider mastectomy, as that seems pretty severe. and since i will start mammo's early anyway . . i don't know. it's all very heavy and makes me wonder if my desire for breast augmentation is selfish/foolish if i have this to contend with also?

then again, if i live to be 102 and never have one mutated cancerous cell, i would reeeeeaaallly regret NOT going through with it.

ahh, what is life without conflict?

[JCsMomma]

It's a tough one, for sure! As far as the biopsies go, I never had a patient with implants who wasn't able to have the needle biopsy. They are guided by ultrasound, so the doctor can see exactly where the needle is going. If there was something to close to the implant to safely biopsy this way, it would mean a surgical biopsy. So, one way or another they would definitely be able to biopsy a breast with implants. The other thing I wanted to say, is that probably why you get a different opinion from a radiologist and a mammographer is because implants definitely make their job harder. There are plenty of skilled technologists that can easily perform a mammo on someone with implants, but it is a technically more difficult exam to perform and evaluate. There is always the factor of human error, and it would be greater with implants. So, there are plenty of reasons not to get implants with your history. BUT, I do see that there are also many many reasons to go forward. I understand how badly you want them, because I am in the same boat. I totally agree with the PP about talking to a medical professional. I would talk to your PS (probably more than one) about your history and your concerns, and see if they honestly would recommend you going forward. They know all the research, the risks, etc. better than any of us and I am sure could help you with your decision. It's just such a hard one!

Sorry if this response is all over the place... my son is crawling on my lap wanting me off the computer