How can a patient advocate for a procedure as a medical necessity to improve quality of life?

I have been reading about Mastopexy and abdominoplasty. I'm getting mixed reviews from doctors. Critics remark that one involves removing tissue so breasts may be smaller (like I care) and the other will leave me with a larger scar and potentially MORE issues than what I am dealing with on my abdomen.

My breasts are sagging, a LOT. I nursed my daughter for 2 years and I'm being told by doctors that this is normal. While I am not looking to end up looking like Frankenstein's Wife, I am not worried about the aesthetics: I'm in pain. My breasts are sore all the time. The skin is stretching and itching the same way my belly did during pregnancy and I'm having to hold them in the shower because of the discomfort. It has taken a turn for the worse as I'm now wearing a bathing suit in the shower for support. This issue, coupled with the scar tissue pain that I have from my emergency C-Section, makes going to the gym an experience in torture. My doctor sent me to an OBGYN who has gone down the list of things it "could be" but refuses to listen to me when I tell her that this has been bad since I had my daughter. It has worsened as I continue to push myself in the gym. No hernias are present. My belly gets red hot sensations, prickly and hyper sensitive to touch or interaction with fabric on a regular basis. It is the incision site and the surrounding areas.

I don't know what to do; it is affecting the quality of my life. I've taken to wearing a compression bra to hold my breasts in place which is relieving compared to underwires/push up non-sense. When does a patient advocate for a procedure as a medical necessity and how can I get my doctor to help me? I'm only 35 years old and the issue with my breasts started 3 years ago while my belly scar has been a raging hot mess since day one. No one will listen to me! I know my life would be so much better but I have no clue what I need to do! I even had a doctor suggest pain meds. I don't want drugs! I want to go jogging with out my breasts bruising!

It sounds as if you may benefit greatly from breast and abdominal surgery! Insurance does not pay for such corrections, even though the problems may be quite impactful on the patient's life, and considers them to be cosmetic.

Brent Moelleken MD, FACS
Brent Moelleken MD, FACS
120 S Spalding DrBeverly HillsCA90212US

Brent Moelleken MD, FACS

120 S. Spalding Drive, Suite 110,
Beverly Hills, CA, 90212, US

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In our present Health Care System Insurance Carriers dictate health care coverage not Doctors. Mastopexy’s (Breast Lifts) & Abdominoplasty’s (Tummy Tucks) are considered by these insurance carries as medically unnecessary surgical procedures. They are usually not provided as covered services.

You are the best advocate for this situation. Individuals save moneys/ funds to buy a motorcycle, boat, car, jet ski, etc. Consider your situation in the same light. Once you have obtained funding consider an ASAPS Member to discus your issues & concerns. Many offer package pricing for Mommy MakeOvers. Best,

Gary R Culbertson, MD, FACS

Gary R. Culbertson MD, FACS
Gary R. Culbertson MD, FACS
18 Miller RdSumterSC29150US

Gary R. Culbertson MD, FACS

Iris Surgery Center, 18 Miller Road, Sumter,
SC, 29150, US

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