Lot of questions vie email and Facebook about Saturday's post about my appointment with the plastic surgeon on Friday. An 18 month wait seem to confirm some idées reçues about "socialized" medicine.
The thing to remember about the French healthcare system is that it's a mixture of public and private. Most doctors do not work exclusively for the public system. Some are completely independent and others have a mix of hours at public hospitals, private clinics, and their own practices.
There are two different payment systems here: state insurance (Assurance maladie) and private insurance companies (mutuelles). The latter are usually offered as part of a job package (not unlike in the US). The way it works is that the private insurance is meant to pay for extras that the state insurance does not cover. A good example would be hospitalization. Basic state insurance will cover 100% a hospital bed in a room shared by one or two other patients. If you have private insurance, however, the mutuelle will pay the difference and you can get a private room.
So everyone, regardless of income or status, gets the basic stuff covered by state insurance. That means that breast cancer treatment is entirely covered - surgery, chemotherapy, radiation therapy, tamoxifen, follow-up appointments, PET scans, MRI's, pain meds - and you never EVER see a bill or have to think for two seconds about how something will be paid for. Just show your Carte Vitale (state insurance card) and everything is taken care of automatically. It is incredibly efficient and I am in awe of their ability to provide this kind of cost-effective quality care with a minimum amount of bureaucracy. Think of it as an "All care, no costly BS" system.
Extra stuff, however, will cost you or the mutuelle, extra.
So what happens with breast reconstruction?
First thing to get clear is that breast reconstruction after a mastectomy is covered by French state insurance. It's not an extra - it's part of the basic state plan. That said, the questions are: how it will be done, when it will be done and where the surgery will occur.
The first question will be answered by me and my surgeon. There are different options but what it looks like is that I will have to have implants. I'm just too darn skinny and there isn't enough laine around my middle to use to make two breasts even though I'm not shooting for much here. I have no desire to look like a Baywatch girl; I'm thinking more along the lines of an 18th century coupe à champagne designed, they say, using the breast of the Marquise de Pompadour (or Marie Antoinette) as a model.
The when and where are equally complex. Essentially, I have three options:
1. The cancer clinic where I have been undergoing treatment now for nearly 2 years. This was my first choice. They know me and I know them. I trust them. My mastectomy went as well as could be given the circumstances and I still remember the kindness of the surgical team as I went under and the excellent aftercare given by the staff. These people saved my life.
I can have the surgery done there but it will take 18 months at least before it can happen. That's the news I got on Friday. But that's not the last word. There are other options.
2. A private clinic that charges reasonable rates. By "reasonable" I mean one where the bill will not go over what the French state insurances pays and what my private insurance (yes, we have one) will cover. That's going to require some research and will take time. There will be paperwork.
3. A private clinic or plastic surgeon who has an excellent reputation but has fees that will far surpass my coverage. This would also require research and a cold hard look at the state of our finances. What is it worth to me and to my spouse to have this done? 5,000 Euros? 10,000 Euros? 20,000 Euros? Who knows.
Now that I am well-rested, well-fed and my head is in a better place, I can start thinking about what I want to do next. Option 2 is the most realistic and I will start working on that this week. I can ask both my GP and my gynecologist at the Franciscans here in Versailles for referrals. If anyone reading this has a plastic surgeon they know and love here in France, please pass on the name. I'd also really appreciate hearing from any Flophouse reader who has had breast reconstruction. How did it go? Are you glad you did it? I'm reading the material they gave me at the hospital and sounds like a lot can go wrong. Scary, and all for something that is, strictly speaking, not necessary surgery. Yvonne (Considering the Lilies) posted this photo. This woman chose not to have reconstruction and instead used the space for a pretty incredible tattoo. Something to think about...