Question

Breast Reconstruction Surgery

Will insurance cover any part of my breast reconstruction procedure?

A Answers (3)

  • AGedge Rosson, MD, Plastic & Reconstructive Surgery, answered on behalf of Johns Hopkins Medicine

    On October 21, 1998, the Federal Breast Reconstruction Law was passed. Since that time, insurance companies have been required to cover the cost of breast reconstruction after mastectomy, including:

    (1) Reconstruction of the breast on which the mastectomy has been performed;*

    (2) Surgery and reconstruction of the other breast to produce a symmetrical appearance;*

    (3) Prostheses and physical complications all stages of mastectomy.*

    In 1985, less than 4% of women had breast reconstruction after mastectomy. In 2007 less than 30% of women underwent reconstruction. Although this is a 7-fold increase, it is still shockingly low. While some women choose not to have reconstruction, this is a very small proportion. The limiting factor is knowledge - women don't know that they can have their breast(s) rebuilt because (1) their surgeon doesn't tell them that they can; (2) they think their insurance company won't pay for it; (3) or there is limited access to plastic surgical expertise. We all have a responsibility to help bridge the gap of knowledge so that more women have access to educational resources and plastic surgeons who specialize in breast reconstruction.

    (*adapted from the American Society of Plastic Surgeons website: http://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/breast-reconstruction-resources/1998-federal-breast-reconstruction-law.html)

     

  • AStuart Linder, MD, Plastic & Reconstructive Surgery, answered

    Insurance should cover both the mastectomy and the reconstruction of your breast for cancer. First, obtain a pre-authorization for services with both the general surgeon and the plastic surgeon. Functional surgeries including cancer exenteration and reconstruction are approved by all carriers including HMOs, and PPO insurances. 

  • AMichael A. Howard, Plastic & Reconstructive Surgery, answered on behalf of NorthShore University HealthSystem
    Michael Howard, MD - Will insurance cover any part of my breast reconstruction procedure?

    Federal law mandates that breast reconstruction surgeries be covered by insurance. Learn more from Dr. Michael Howard on behalf of NorthShore University HealthSystem about how insurance covers breast reconstruction surgeries.

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