First published in Volume 13 of The Examined Life Journal: A Literary Publication of the University of Iowa Carver College of Medicine on 11/14/25. Printed journal available for purchase.

At 37, I reduced my breast cancer risk from 87 percent to 4 percent with a prophylactic double mastectomy. Reconstruction options (implants, tissue, or flat) have tradeoffs. Using my belly fat required three surgeries, leaving me scarred hip-to-hip and under my breasts. My goal for reconstruction was to stay connected to my power, in a discomfort-free and cancer-free body, while dodging depression from how my body looked or felt. Despite health-focused preparations, my scars grew into keloids—abnormal proliferation of scar tissue forming after a surgical incision. “That’s just how some bodies heal,” said my doctors.

I had fifty-eight inches of purplish-red, itchy, and raised scars.

For months I worked with physical therapists, covered by health insurance, to regain my range of motion and soften painful scars. Scars impact fascia —connective tissue surrounding muscles and organs. When fascia doesn’t slide, our bodies function less. Each surgery re-injured my fascia, requiring months to retrain my muscles to move like they did before knowing the knife.

Once I could drive, wash my hair, and swim again, insurance stopped covering PT. I still couldn’t carry my children—so I pushed our stroller to pre-school pickup. My scars itched. A lot.

I couldn’t accept my new normal, even though insurance deemed it adequate. I continued therapies out-of-pocket and tried products—probably spending $5,000 outside insurance over two years. I’m grateful for this privilege. Many patients can’t pay bills, let alone invest out-of-pocket. Reaching for a thriving post-surgery-body-normal should be accessible for all.

With fifty-eight inches of scars, silicone tape was time intensive. Each strip needed to be washed and dried. When combined with massage, scar support averaged forty-five minutes daily. We nicknamed the drying tan strips fly traps. My boys, 3 and 5 at the time, would routinely get their curious fingers tangled in them.

I’ve had awkward encounters with people sneaking glances at my chest. Confused by their attention, I’d realize I led their gaze by scratching my scars—unable to satiate no matter how much pressure I applied. This itching was not like a bug bite, annoying and at surface level. It was from deep within and unreachable.

At a ten-month follow-up, my plastic surgeon asked how I felt about my body. I shared I was generally happy, except for my scars constant itchiness. He recommended lasers for my almost one-year-old breast scars. Since my abdominal scar was older, he thought lasers wouldn’t improve aesthetics so he offered scar excision.

I had a visceral reaction thinking about being cut again. I wanted input. My PT recommended I weigh an excisions impact on my fascial function. After twenty-two months, I was engaging my core meaningfully and didn’t want to reset that clock. My aesthetician believed plastics offerings were superior. My counselor asked, “When seeing fresh stitches hip-to-hip, how will you feel?” Every cell in my body winced. It was hard being reminded about the five days in the hospital after reconstruction.

I asked my surgeon if lasers could reduce my two-year-old scar’s itching. He thought yes. Decision made! His office resubmitted insurance claims for two laser treatments instead of one.

Weeks later, I received a denial for laser surgery because my plan excludes coverage for treatment, services, and supplies for cosmetic or beautifying purposes. The two-page denial ended with: This exclusion includes removal of keloids. Therefore, the request is not covered.

I had an oncology follow-up the next day. When my breast surgeon learned about the denial, she shook her head.

“Have plastics talk with insurance, sometimes it takes multiple tries. Yours are bad, treatment should be covered.”

Plastics was happy to engage on my behalf. To aid their efforts, I found the quoted text used for denial on page seventy-two of my 125-page Certificate of Coverage. I underlined what insurance conveniently omitted: Treatment is covered: when associated with covered reconstructive surgery due to an illness; This exclusion does not apply to the reconstruction of affected tissue incident to a mastectomy or for complications of mastectomy.

I reminded them that under the Women’s Health and Cancer Rights Act (WHCRA) of 1998, coverage must be provided for all stages of breast reconstruction on which the mastectomy has been performed and treatment of physical complications of all stages of the mastectomy.

They checked the coding and passed this on.

Insurance denied again. My surgery was in three weeks. My surgeon had a “peer-to-peer” with a doctor representing insurance, explaining the medical necessity of treatment. Insurance denied again. Not all plans have keloid exclusions—I could delay and change plans.

Open enrollment had closed. I’d have to wait an entire itchy year to explore. Plus the longer I waited, the less likely my symptoms would improve. Insurance clarified even if I changed plans, I might not be covered—member wouldn’t clearly meet those criteria since no clear physical functional deficit involved, and unclear failure of more conservative therapies.

The WHCRA doesn’t limit covered treatment of complications to trouble seeing, hearing, mobility, communication, cognition, or self-care.I was constantly itchy—no amount of pressure, creams, or Benadryl softened the edge. How were the hundreds of hours I’d spent applying dozens of expensive products over two years not considered “failure of more conservative therapies”? Insurance also stated this is not felt to fall under WHCRA as it isn’t reconstruction per se. But I wouldn’t have itchy keloid scars if I hadn’t amputated both breasts, per se.

To add more salt to my wound, I learned insurance approved the excision. They’d pay for the more invasive procedure, with a longer recovery and higher infection chance. So they believed my symptoms warranted treatment, at least.

I found myself, again, at a split in the current. One that felt annoyingly familiar considering my fourteen-year BRCA journey, shrouded in medical uncertainty mist, without guaranteed outcomes, and endless inputs.

For many, insurance’s denial would be the final word. Who are we to know what’s best for our bodies? And, if we know, but it’s not affordable, how do we live with that outcome? Even when well-resourced—financially, networked, and informed—dealing with medical unknowns within a system that prioritizes cost cutting over quality of life, is an unscratchable itch.

I paid out-of-pocket. Again.

I needed to reduce the energy required to float out of my mastectomy recovery riptide. I surrounded myself with care providers I trusted, advocated for myself, and satisfied this specific indignation. Given all my body had been through, and all I’d already spent outside the insurance-sanctioned system, the chance to end the intense itching from within connected me stronger to my power. Now I could swim into my future without slowing down to scratch.