Q and A:
My most important question, I have Aetna insurance. Is a breast reduction, tummy tuck & upper arm reduction covered? In August I will be on Medicare also. I had a gastric bypass two years ago and have a lot of loose hanging skin which is not allowing me to do physical activity.
Dr. Laverson answer:
Great to hear from you Robin, and congratulations on your weight loss!!!
Because of the insurmountable obstacles that third party payers impose upon many surgeons, myself included, our office has eliminated them from the doctor-patient relationship as much as possible.
We don't want to request permission ("pre-authorization") from non-professionals to treat patients, we don't want to be told what procedures we're allowed or not allowed to do, what drugs we can and cannot prescribe, where to do our procedures, what other specialists and providers we must or must not refer to, and how much we'll be paid for our services. Third parties who are paying for care regulate that care, and they do so without any medical license or liability. They are a for-profit business. We're health care professionals. We don't always agree with insurance company profit-based decisions. From a practical standpoint, insurance related paperwork and administrative responsibilities can be overwhelming.
Because I'm accountable to patients for quality and safety, I must maintain some control over the decision making process in evaluation and management. I like discussing with each patient what they believe to be best for them, and being able to implement a patient-desired plan, as you yourself have articulated (breast, tummy tuck, arms). We must deliver the type of results patients want without restrictions and burdens placed upon us by entities who don't know us, who don't know our patients, and who aren't as committed as we are to the best possible result. Insurance companies, in general, commoditize your care. You're a set of numbers to them. Your premium payments are income they try to maximize, but your care is a cost they don't want to incur. Insurance offers baseline standard care at the least cost. The fee that most payers provide for surgical procedures doesn't come close to covering the true cost of each procedure. If multiple procedures are performed, as you're requesting, insurance only pays for the first one. If two sides are done (e.g., breasts, arms), insurance won't pay for the second side. Billers must be paid, office rent, staff, equipment, supplies, insurance, and utilities must be paid to remain in practice. Although you pay your premiums, and you're thus entitled to care, insurance reimbursement to surgeons is so paltry that after all these expenses, surgeons are not being paid for surgery, we're actually paying for the surgery too. The arrangement is very favorable to insurance companies, and I participated in that arrangement for over twenty years. Thinking I was supporting patients, I was merely enriching third party payers, starving myself and my office, and diminishing my own capacity to continue caring for patients.
I believe patients deserve the best I can deliver. Patients are not numbers here, they're respected human beings with hopes, dreams, and each with his or her own unique, valuable, and special identity. High quality is costly Robin. Our goals and the goals of third party payers are irreconcilable.
So, in essence Robin, if you must have these procedures covered by insurance, your next step should be to consult with plastic surgeons within your network, who accept the insurance you have. This in no way means your care will be less, or your result not as good. It just means that for insurance to pay, you must follow their rules. This means to work with their contracted specialists. I am no longer a Medicare participant. As long as you see a board certified plastic surgeon, and you trust that surgeon, your outcome will likely be just fine. You've already done the hardest part, and the most important part, losing your extra weight.
Don't hesitate to contact us if questions.
The Journal of Female Health Sciences: JFH.TD.13.098
SCIENTIFIC ANALYSIS REVEALS MAJOR DIFFERENCES IN
THE BREAST SIZE OF WOMEN IN DIFFERENT COUNTRIES
– U.S. women have a significantly larger mean breast volume than women born in other countries
John D. L. Anderson – Curator of Human Anatomy, New Delhi School of Applied Sciences
Susan C. Chandler – Senior Lecturer, Aesthetic Surgery, Braga Medical School
Megan A. B. Mason – Senior Researcher, Department of Mathematical Statistics, UISS Chennan B. Khan
– Professor, Diagnostic Technology, New Delhi School of Applied Sciences Jennifer E. Lindsay –
Associate Director, ND Garment Ltd
Richard M. Sandler – Professor of Radiology, Camiry University
Liu G. Wong – President Emerita of Atape Institute of Human Anatomy
In recent years the breast size (i.e., bra cup size and bra band size) of women has been studied in a number of national and regional research projects. Most of the studies have been conducted by universities in cooperation with companies within the lingerie industry and other commercial stakeholders. However, the local studies have not been able to provide internationally comparable results regarding the factual breast size (i.e., breast volume or breast tissue volume) in different countries.
Increasing knowledge of the breast size variation of women from different countries is needed as a guideline for example for the product development and targeting of marketing actions of clothing industry and cosmetic surgery providers.
Recently a group of scientists made a thorough international data analysis with statistically reliable results. The breast size data of women born in 108 countries were converted to a comparable format and analyzed. The study analysis defined in a scientific way the average breast size of 28 – 30-year-old women broken down by country of birth. The analysis was based on accurately measured breast tissue volume of the women in the material. In order to facilitate the practical applicability of the study results the outcome of the final analysis was also expressed as bra cup sizes using the EU bra size standard as a reference.
The study analysis revealed that there is a considerable variation in the breast tissue volume, i.e., the factual bra cup size, of women depending on their country of birth.
For example, women born in the U.S.A have by far larger breasts than women in any other country, while women born in Africa and Asia, particularly in the East Asian countries, have the smallest breast volumes.
Reprinted from the Wall Street Journal Book Review Section, 12-29-2016
In 2012, New York Mayor Michael Bloomberg announced the Sugary Drinks Portion Cap Rule (aka the Soda Ban) prohibiting the sale of sugary beverages of greater than 16 ounces. His administration had successfully curtailed smoking in restaurants and bars, a move that inspired similar ordinances nationwide, and supporters of the Soda Ban considered the new measure a concrete proposal to respond to the epidemics of obesity and diabetes that have afflicted the country. (Diabetes is the seventh leading cause of death in the U.S.) New York courts tanked the rule, saying that the Board of Health had exceeded its regulatory authority, but not before soda companies had undertaken a counterattack, hiring canvassers to solicit signatures on the street and even launching a perverse television ad campaign claiming that the rule would adversely affect lower-income families.
THE CASE AGAINST SUGAR
By Gary Taubes
Knopf, 365 pages, $26.95
One wonders whether the debate might have been different if everyone involved had been able to read Gary Taubes’s blitz of a book, “The Case Against Sugar.” In his 2010 best seller, “Why We Get Fat,” Mr. Taubes argued that carbohydrates like grains and starchy vegetables were behind the obesity epidemic. “In a world without cigarettes, lung cancer would be a rare disease, as it once was,” he wrote. “In a world without carbohydrate-rich diets, obesity would be a rare condition as well.” This time around, he focuses on the “unique physiological, metabolic, and endocrinological effects” that sugars have on the human body, how they trigger obesity and diabetes, and the role that the food industry has played in covering up sugar’s contributions to our national health crisis.
Mr. Taubes’s argument is so persuasive that, after reading “The Case Against Sugar,” this functioning chocoholic cut out the Snacking Bark and stopped eating cakes and white bread. It was easier than I expected: Within a week, I was so sensitive to sugar that I could taste it in the weirdest places; in a restaurant salad, for instance, and in my organic yogurt. When I ate a piece of Thanksgiving squash pie, it made my head buzz. I felt like I’d just taken a hit off a tank of nitrous oxide.
For me, getting off sugar was a health tweak, but for many Americans, it may be a matter of life or death. More than 35% of Americans are considered obese, and the health risks of obesity include Type 2 diabetes and heart disease. Almost 50% of Americans have diabetes or pre-diabetes, a condition that features higher than normal sugar levels in the blood—sometimes much higher. Diabetes has long been considered the penalty of obesity, and obesity, reports Mr. Taubes, has long been blamed on a couple of deadly sins—gluttony and sloth—and the consumption of “all calories together, rather than sugar by itself.” The idea that we get obese because we take in more calories than we expend is a notion so ingrained in public-health conversations that “arguments to the contrary have typically been treated as quackery.”
“The Case Against Sugar” builds upon the case he made in “Why We Get Fat,” carefully laying out the science to show that a sugar calorie is not like a spinach calorie but “triggers the progression to obesity, diabetes and the diseases that associate with them.” Here’s how. Sugar is a simple carbohydrate. Carbohydrates in your food are the source of glucose in your blood, and glucose powers your cells. Insulin is a hormone that transports glucose from your bloodstream into your cells and, as Mr. Taubes puts it, “signals the fat cells to take up fat and hold onto it.” Under normal conditions a cell has abundant receptors for insulin and has no problem processing the glucose. But if you consume high, constant volumes of maple syrup, corn syrup, agave, honey, raw or refined sugar, your pancreas responds by producing more insulin, and cells adapt by reducing their responsiveness to it. (The same thing can occur when you eat refined starches like white bread, white rice and potatoes; they are digested so rapidly they flood your bloodstream with glucose.)
What happens next? Basically, the cell stops listening to the insulin knocking at the door. This is insulin resistance. When the cell starts refusing to take glucose from the blood, glucose builds up in the bloodstream, causing the pancreas to make even more insulin, which (you will recall) tells the cells to hold onto your fat. It’s a feedback loop that causes obesity and culminates in Type 2 diabetes. (Type 1 diabetes, which is less common, derives from insulin deficiency.) The link between obesity and Type 2 diabetes is one of such interdependence that the term “diabesity” has been coined.
Methodically, relentlessly, Mr. Taubes argues that “bad science” over the course of many years primarily blamed obesity, diabetes and other “Western diseases” on overeating or lack of exercise or both. This mistake, made by clinicians starting in 1907, became institutionalized because the medical field tends to be obedient to “a small number of influential authorities.” But as the evidence against sugar built, and more researchers reported the correlation between sugar calories, obesity and diabetes, the food industry moved in to protect its turf. Mr. Taubes cites one 1953 ad in which Domino Sugar claimed “3 Teaspoons of Pure Domino Sugar Contain Fewer Calories than One Medium Apple.” That’s a little like saying a cubic meter of methane gas costs less to produce than a cubic meter of sunshine.
“The Case Against Sugar” is a history of the food industry and the medical science that has both supported and denied the role of sugar in disease. It explores the addictive aspect of sugar (which anyone with a toddler is familiar with); the “peculiar evil” of marketing sweets and sweetened cereals to children; and the industry’s 60-year effort to shift the blame for obesity and diabetes to saturated fats and behavior. In the 1960s, for example, the Sugar Association, a trade group, became concerned about the emerging evidence linking sugar to diabetes and heart disease. It worked hard, Mr. Taubes claims, to “combat the accumulating evidence from researchers,” by financing industry-friendly research and besmirching the credibility of scientists whose research suggested that sugar was unhealthy. These efforts were successful enough to influence the language of FDA reports on sugar in 1977 and 1986, as well as the first government-compiled Dietary Guidelines, released in 1980, which unsurprisingly declared that fat caused disease.
Opinions began to change in 2007 when the “Sugar Papers,” a trove of internal documents detailing the relationship between the sugar industry and medical researchers in the 1960s and 1970s, was discovered by Cristin Kearns, the general manager of a large group of dental practices. The trove—which she found by (wait for it . . . ) googling—revealed that the sugar industry had worked with the National Institutes of Health to create a federal program to combat tooth decay in kids that did not recommend limiting sugar consumption. Mr. Taubes convinced me that these food companies deliberately set out to manipulate research on American health to their favor and to the detriment of the American public.
As the author’s own account shows, he is hardly the first to warn of the toxicity of sugar. But busting sugar is tough: In the early ’80s, high-fructose corn syrup replaced sugar in sodas and other products in part because refined sugar had developed a reputation as generally noxious, and corn was a vegetable, for God’s sake. This is a bait and switch. All sugars produce the same biological results if you consume enough. Soda is a particularly pernicious way to overdose on sugar because it’s just sweetened water—drinking a can of Pepsi® doesn’t seem analogous to eating cheesecake.
This year, San Francisco became the first American city to require health warnings that say: “Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay” on public advertisements after the beverage industry failed to get a court order to stop it. Starting on Jan. 1, Philadelphia will be the first major city to institute a 1.5 cent per ounce tax on sodas and other sugary drinks. But the battle goes on. Between 2009 and 2015, soda companies spent $106 million opposing local and federal public-health initiatives, according to Mr. Taubes. Just last year this paper ran an article about the Global Energy Balance Network, a nonprofit funded by Coca-Cola® that “suggested Americans were overly fixated on calories and not paying enough attention to exercise.” The story will sound familiar to any reader of Mr. Taubes’s book.
“The Case Against Sugar” should be a powerful weapon against future misinformation. In 2015 the New York Times’s health columnist Jane Brody reported that she’d heard people saying: “Let me know when the nutrition gurus make up their minds and maybe then I’ll change my diet.” Well, there is a lack of agreement about the amount of sugar that can be consumed in a healthy diet. But “ultimately and obviously,” writes Mr. Taubes, “the question of how much is too much becomes a personal decision, just as we all decide as adults what level of alcohol, caffeine, or cigarettes we’ll ingest.” Consider the evidence. Decide for yourself.