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Breast reductions are a medical necessity for some women, so why aren't they covered by Medicare?

by Naomi Chainey - 16/08/16, 12:15 AM
Large breasts can cause some women health issues such as back, neck and shoulder pain.

Large breasts can cause some women health issues such as back, neck and shoulder pain. Photo: Stocksy

Last week, my friend Tahlia started a gofundme page to raise some cash for a breast reduction. Titled "Ta-Ta Tatas" the page features an image of silky lingerie and asks the public to contribute $10,000 to help her trade her unwieldy H cups for a more manageable D.

There's a sense of fun about it, reflecting Tahlia's good humour and sense of aesthetic, but upon reading the full explanation of why the funds are needed, one cannot help but be outraged by the mistreatment Tahlia has so far received at the hands of our medical establishment.

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Tahlia's surgical reference photograph.
Tahlia's surgical reference photograph. Photos: Supplied

At the tender age of 26, Tahlia is already post-menopausal, the result of ovarian failure that likely began in her teens when she first sought help for symptoms. Doctors quickly identified a hormone imbalance and prescribed drugs to correct it, but when symptoms persisted into her 20s, they began to look more intently for a cause.

What followed was six years of swinging diagnoses. Had Tahlia's ovaries failed or not? The verdict changed with each test. "The issue was being masked by the hormone therapies they were giving me," Tahlia explains to me. "It never seemed to occur to them that their own drugs were influencing the results."

The result for Tahlia was an emotional rollercoaster, as hope of ever having her own children was repeatedly given and snatched away. "Ovarian failure means no possibility of conceiving," she says. "After saying I would never have children, they changed their minds and told me I had a small window, so my partner and I agreed to start trying. Then they told us I was actually fine, so we assumed we had more time. Now they've reconfirmed that it will never be possible. It's just been devastating."

Another consequence of the revolving door diagnosis has been that Tahlia has gone years without the appropriate oestrogen therapy to protect her bone density. Post-menopausal women are at much higher risk of osteoporosis, and Tahlia has now developed its precursor, osteopenia, a situation giving Tahlia's long held desire for a breast reduction a new sense of urgency.

"I'm at risk of developing a dowager's hump," Tahlia tells me. "From fractures in the vertebrae. I've already got a curvature in the spine." Apparently having four kilograms of weight on your chest is a dangerous thing when your bone density is compromised. Tahlia's breasts may actually cause her permanent spinal damage if she does not have them reduced in a timely manner.

Astonishingly, given the medical necessity of the operation, Tahlia's impending surgery is hardly touched by Medicare. Of a total of $11,715, Medicare will contribute $1,173. A figure which barely covers the booking fee.

Adding insult to injury, Tahlia's capacity to pay the gap has been seriously hampered by an inability to work for almost two years due to severe endometriosis.

If you're unfamiliar, endometriosis is a condition where the tissue that usually lines the uterus starts growing outside of it, wreaking havoc upon the pelvic organs and bleeding into the abdominal cavity during menstruation. It can cause intense pain and fatigue, and often leads to digestive problems, reduced fertility and painful sex.

On average, it takes seven and a half years to diagnose, with women reporting that their symptoms are routinely brushed off by acquaintances and medical professionals alike. Certainly this was Tahlia's experience. In her case, the diagnosis took twelve years.

"I was vomiting every day at work," Tahlia recalls, "eventually I just couldn't do it anymore." After a decade of being told to take a Panadol and think positive, Tahlia had become too incapacitated to be independent by the time endometriosis was finally floated as the culprit. Then came the long waiting period for the diagnostic laparoscopy – a small surgery allowing doctors to see the inside of the abdominal cavity, identify the problem, and laser out any tissue that should not be there.

Tahlia's pelvic region was covered in superficial lesions which have now been removed. She tells me this with a strong sense of validation while still recovering from the operation. Resentment for the pack of medical professionals whose dismissive attitudes had to be battled for this result is palpable.

The next battle is, of course, a financial one. While Tahlia is hoping to recover well enough to go back to work, the damage to her finances is already done, and the breast reduction surgery is not one that can safely wait. Gofundme is a last resort, with Tahlia now depending on the generosity of strangers to save her vertebrae from fracturing.

Tahlia's story represents a massive failure on the part of our medical establishment to support women's health. Her experiences of dismissal and misdiagnosis are, sadly, not uncommon, and Medicare's failure to support a medically necessary procedure shows us exactly where our government can start improving its services.

 

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