Ask the Plastic Surgeon

Q: Stress. It's been my companion since my breast cancer diagnosis. Hopefully you can help with some advice on my latest struggle. My cancer surgeon thinks that I should have a "lumpectomy" on the involved side and would, therefore, not need a reconstruction. I'm thinking that I should have both of my breasts removed in order to give me the best chance for a cure. If I have both breasts removed, then I have to decide what type of breast reconstruction to have. A consultation with a plastic surgeon gave me some answers, but honestly, has left me with even more questions about what to do. I guess I feel so rushed to make a decision. What would you advise?

Breast cancer diagnosis is a literal shock to the system. All of a sudden, you have to deal with the emotional fall-out of the diagnosis, and the stress of trying to make a myriad of decisions. It's okay to take your time in making those decisions. Genetic testing may help in deciding whether or not to have both breasts removed because it may give some idea of your future risk of developing cancer in the opposite breast. I'm certain that both your breast cancer surgeon and your plastic surgeon would be happy to clarify any confusion about the choices that need to be made. If this means a follow-up consultation, that's okay. Sometimes my patients find it helpful to bring a friend, or loved one, along to appointments as another set of ears to help them remember details and options.
      The most important surgery is the one that gives you the best chance of being cured of the cancer. As for the reconstruction, if needed, some find that having it done, or started, at the same time as the mastectomies is an optimum solution. They like the idea of accomplishing as much as possible during the initial surgery, and find it emotionally helpful as well. However, if you're undecided about the type of reconstruction that you want, or, if you don't know if you want a reconstruction, it can always be done at a later date. The bottom line is that you need to listen carefully to your surgeons' recommendations, keep asking questions and trust your instincts to do what feels right to you.

Q: Lately, I've noticed that my upper eyelids are sagging and blocking my line of vision particularly when I have my head down while I'm golfing or reading. I've heard that this can be fixed, and that insurance can cover the cost. If this is true, what do I do next?

A:  It is true. We can eliminate the impact that your sagging lids are having on your eyesight. A procedure known as a "blepharoplasty" corrects sagging eyelids. It is usually covered by insurance if your eyesight is significantly impaired.
    The first thing that you need to do, to find out if you are a candidate for coverage from your particular insurance company, is to see your eye doctor for what is called a "visual-field exam." This test documents to what degree your sagging skin is obstructing your field (or range) of vision.
    An ophthalmologist or a plastic surgeon can perform the surgery needed to correct the problem. Before surgery, your surgeon will send your insurance company a request for "prior approval" that, along with the results of the visual-field test, will include photographs that show your eyelid levels in relation to your pupils.
    There should be two sets of photos - one set with your eyelids taped upward, to demonstrate where the lid level should be, and one set, without tape, to show your existing eyelid level. The insurance company will notify you, and your doctor, as to whether you are approved or denied coverage for the proposed procedure.

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