A Hope Chest

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A Hope Chest

What is it like to lose a body part? How devastating is it to miss a physical part of you? After one woman coped with the concept of losing her breast after surviving cancer, one plastic surgeon rallied to give back a part of her that could have been lost forever.

Whenever Laura Ostrer lifted her shirt, she said she looked like a monster. Her left breast was gone. Her nipple was removed as well. In their places were a half-dozen protruding scars and a lumpy bubble where an expander was placed under her skin. When she gazed in the mirror, she couldn’t see herself – at least not the self she knew. That feminine, spunky woman she’s known for the past 59 years was no longer looking back at her. And that was devastating.

“I had all kinds of drainage scars and a big gashing scar under here,” Ostrer says, tracing a line with her index finger from her mid-breast laterally to her side, under her arm. “I had another big scar that made me look like Frankenstein.”

She lets out a deep sigh and looks up.

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“You get used to it. Sort of,” she shrugs quietly. “Then you realize these are battle scars.”

After undergoing a total mastectomy on April 17, 2012 perpetuated by three tumors in her left breast, Ostrer’s chest was decimated. And, if surviving breast cancer and undergoing invasive surgery wasn’t enough, to compound matters Ostrer didn’t have health insurance. To put it simply, she didn’t have many options.

Sadly, no part of Ostrer’s story is unique. It is expected this year alone that about 232,340 new cases of invasive breast cancer will surface in women living in the U.S., according to the American Cancer Society’s estimates. And with about 23 percent of Broward County women and 21 percent of Palm Beach County women ages 25 and older living without health insurance, the treatment options for these women – much less reconstruction of the breast – are limited. 

A little history

In 1998 the Women’s Health and Cancer Rights Act was passed that made mandatory coverage of reconstructive surgery and the cost of the implant for women undergoing mastectomies who were covered by insurance. Too, symmetry procedures to ensure the other breast mirrored the prosthetic one were covered. Breast reconstruction and implants were no longer con- sidered solely “cosmetic” or “elective.” The revolutionary edict changed the lives of thousands of women who were devastated not only with the cancer diagnosis, but also the loss of a body part so associated with their sense of being a woman.

But for the thousands of other women who don’t have insur- ance or who are denied coverage, they have to find other routes to pay for their mastectomies. And once that’s discovered, recon- struction is a whole different animal.

Like everyone else, Laura Ostrer never thought she was going to get sick. By all previous estimates, she was a healthy person. Up until the diagnosis last year, her skin glowed, her hair shined, and admittedly, she didn’t like to lie down unless, as she says, “I was on my deathbed.” The only time she needed to see the doctor was a few years ago to remove a piece of iron from her hand when she tripped and fell on an ill-placed garden sculpture.

Ironically, Ostrer was diagnosed with cancer during the only time in her life in which she wasn’t covered by health insurance. They say cancer doesn’t discriminate, and in this case, it doesn’t discriminate between those insured and those who are not.

Originally from Great Neck, N.Y., Ostrer moved to Boca Raton in 2005 with some savings she amassed from her real estate career. After moving to Florida, Ostrer got a license to sell real es- tate and do property appraisal. She was self-employed, and when it came time to buy health coverage for herself, Ostrer was stuck deciding whether or not she could pay the $10,000-a-year cov- erage. The vacillation became a moot point when one insurance company denied her coverage after her New York general practi- tioner did not send her medical records in time. Ostrer thought she could manage living with no health benefits until the real estate market picked up so she could comfortably afford coverage and stop living off her savings. After all, she was healthy. And then she got cancer.

“I never thought in a million years that this was going to hap- pen to me,” she says from her screened-in back patio, where she sits on a cushioned chair, right leg dangling atop her left. Dressed in a loose, black cotton long-sleeved shirt with a scoop neck that shows just a peek of the star tattoo above her left breast that she got when she was 17, Ostrer looks far healthier today than she did a year ago. She lives with her Yorkshire terrier, Cricket, in a quiet Boca Raton town home that was left to her and her brother after their father passed. With the sound of Bob Dylan’s scratchy voice from her iPod speaker filling the dead air, Ostrer recounts how her life took a turn. A remarkably independent, educated woman who raised her son alone and saw him through law school in Michigan, Ostrer never felt the need to rely on anyone except herself.

And then she got cancer.

She first felt the hard lump in her left breast in January 2012. Like most women, she wasn’t even looking for it. Her thumb grazed it as she was shifting around. The lump was firm, pea-sized and stationary. It didn’t hurt when she touched it, but her breast ached. Right away, “I knew it wasn’t good news,” Ostrer says. “My breast was achy for about a year, but I didn’t know there was a lump growing in there.”

Insurance is a funny thing. Just like an eager waiter who checks on your table too many times when you don’t need him and then disappears when you do, insurance seems to come and go at inopportune times. Now with no health benefits, Ostrer called a radiologist friend from North Carolina for advice. Call Komen right away, the friend said. Get into their system because they have grants for people just like you.

Ostrer picked up the phone and dialed Susan. G Komen for the Cure, the nation’s largest breast cancer organization, and asked how she could qualify for a breast cancer grant that would cover her surgery. And – get this – she hadn’t even seen the doctor yet. Her cancer wasn’t yet diagnosed. All she knew was she needed to get into the Komen system if her fears were met. “I didn’t know what to do,” Ostrer remembers. “I never had cancer before. And, I never had been without health care insurance before.” 

Ostrer received that Komen grant, which covered the mastectomy. Relief hit her. The majority of a surgery that was potentially $80,000 in costs was going to be covered. And after getting an MRI on her breasts, it was discovered she had not one, not two, but three lesions in her left breast. Her surgeon, Dr. Robyn Moncrief, said there was no choice but to do a to- tal mastectomy. Bluntly put, Ostrer’s left breast was going to be taken from her.

“They give you enough Time To recovery  from surgery physically,  But not mentally and emotionally.” – Laura Ostrer 

Medical Mavericks

In many ways, Ostrer is the county’s luckiest unlucky woman. She’s a wom- an who rolled the dice in a high-stakes gambling game, went all in on a prom- ising hand, only to end up losing the lot. But as they say, all you need is a chip and a chair, and you’re still in the game.

On March 30, during her second visit with Dr. Moncrief, the physician brought up a name that would forever impact Os- trer: Dr. Matthew Goodwin. Moncrief said that because they were probably go- ing to take Ostrer’s entire left breast, she’d need a good plastic surgeon to reconstruct it, and Moncrief recommended Goodwin.

On her first office visit with Good- win, weeks prior to her surgery, Ostrer remembers Goodwin greeting her with a friendly, “Oh, so you’re Laura O. I’ve heard so much about you,” alluding to Moncrief and Goodwin’s previous con- versations about the patient.

“Keep in mind, I hadn’t cried yet,” Ostrer says. “But when we started talking about reconstruction, that’s when I broke down. Because it really hit me that I was losing a piece of my … my breasts.”

For those who go through life never having to worry about losing a limb, a physical part that helps identify a whole, it’s difficult to equate the profound im- pact of losing one’s breasts. No amount of writing, no epic documentary or movie will ever be able to emote the profound feeling one has when confronted with the removal of his or her body part.

Chances are Goodwin will never personally know what it’s like to lose his breasts. (Statistics show that 1 in every 8 women will be faced with invasive breast cancer, whereas it’s 1 in 1,000 for men.) But as a plastic surgeon who completed a fellowship in breast reconstruction, the Palm Beach County-based doctor has worked with countless patients who have lost their breasts from cancer treatment – and can understand the loss is much deep- er than aesthetics.

“I would think if someone was cut- ting off a part of me, I would miss it,” Dr. Matthew Goodwin empathizes. “If some- one was cutting my arm off, I’d miss it.”

A humble man who approaches his job with workman-like tactics, Goodwin is perhaps the antithesis of the Hollywood- inspired “Dr. 90210” and the narcissistic plastic surgeons on “Nip/Tuck.” He grew up in Virginia with a peripheral interest in becoming a doctor. His father’s friend was a physician, and Goodwin remem- bers laughing along with Dr. Heathcliff Huxtable on “The Cosby Show.” But after applying to medical school and watching a plastics case, Goodwin was hooked.

“I was just amazed,” he recalls. “It was like engineering with people’s bodies on the outside.”

And as he accepted Ostrer as a pa- tient, that’s what he was hoping to do: Give her the body that would make all the pains of breast cancer go away and allow her to smile again.

Moving Forward

“I don’t remember the first time looking at myself after the mas- tectomy,” Ostrer says. “I really don’t remember what it was like. It looks like that the second, the third and every other time you look at it, so you forget about the first time you look at it.”

What she does remember are the scars, her lack of a nipple, and the tar- nished look of a woman who had gone to war and come back to fight again.

Ostrer never considered going with- out reconstructive surgery. She didn’t want to be left with one side of her chest intact and the other flat. Some studies say recon- structive surgery and implants improve the psychological and emotional health of a woman who has had breast cancer, and for Ostrer, it was something she felt she needed. But there was one problem: The Komen foundation did not cover recon- structive surgery. And Ostrer didn’t have the money to pay for this procedure that could cost up to $8,000.

As Ostrer says, “I was going to beg, borrow and steal” to pay Goodwin for his service.

“I couldn’t think of dollars and cents at that point,” she says. “They give you enough time to recover from surgery phys- ically, but not mentally and emotionally,” she says of the medical system and surgery schedule.

“It’s hard,” she says, her voice trail- ing off. “It was hard for me,” her voice repeats.

Goodwin was in the operating room for Ostrer’s mastectomy, there to place the expander once the breast tissue was re- moved. He saw her a handful more times throughout the year for follow-up visits, to fill the expander with saline, change to a permanent implant, and then perform the nipple construction.

It wasn’t until about the third visit that Ostrer discovered her reconstructive surgeries (three in total) were going to be done at no charge to her. As she sat in a chair at Dr. Goodwin’s office, Ostrer was in total disbelief.

“I told him I was so grateful,” she re- members. “And then I started to cry.”

Dr. Moncrief, Ostrer’s breast surgeon, isn’t surprised by Goodwin’s actions. As a breast surgeon, Moncrief sees several hundreds of patients a year. And, in her estimates about 4 to 5 percent of them do not have health benefits. In fact, when she mentioned to Goodwin last year that she had an uninsured patient about to un- dergo a mastectomy, he said to Moncrief, “Send her my way. I’ll see what I can do.”

“We have a multitude of plastic sur- geons in Boca, but there are only a handful of surgeons who want to do this type of surgery,” Moncrief says, referring to breast reconstruction surgery in general. “Matt is one of my go-to guys all the time. He cares about what he does. Laura’s story is what it is. There are plenty of women who are insured and not insured. … We are very fortunate in Boca to have doctors who donate their time and get companies to donate the implants. They really go above and beyond. And Matt’s one of them. He’s really good at his craft, well trained and really generous.” 

To this day, Goodwin downplays his free procedure as something anyone would have done if they could. He says he’s not the only doctor who takes on cases like Laura Ostrer’s. He’s careful to say he’s done nothing extraordinary. He brings up the fact he knows several plastic surgeons who mitigate cleft palates and do other forms of mission work that are greater than his own actions. He thinks it’s a physician’s duty to provide for those in need, as he has in the past with Project Medishare, a non-profit that provides care for those in Haiti, his mother’s birthplace. 

He’s here to make a living and pro- vide for his family, Goodwin says, so he can’t do all cases pro bono, nor would that be fair to his office and surgical teams and the slew of other people whose time and talents are involved. He can count the number of times on both his hands and feet that he’s been able to donate his work since he moved to Florida six years ago with digits left to spare. 

But some part of Ostrer’s story must have struck him. “She’s already going through a traumatic experience of go- ing through breast cancer and having her breast cut off, so she should have the right to have reconstruction,” Goodwin rea- sons. “I think every woman should.” 

As for Ostrer, life is picking up for her. She just needs to get her areola tattooed, and her reconstruction will be complete. She’s in the process of renewing her real estate license and currently taking con- tinuing education courses for it. She has a boyfriend, Larry, who stood by her during the mastectomy, and her son is considering moving from New York to Florida to be closer to his mother. 

Ostrer still doesn’t have insurance, which is one reason she hasn’t made ap- pointments for follow-up breast diagno- ses. But despite her hardships, she knows life has dealt her a fortunate hand in which she’s thankful she can continue to play. With much appreciation to a few re- markable people, Ostrer managed to turn a chip and a chair into a new life.