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Will insurance cover any part of breast augmentation surgery costs?

Erik A. Hoy, MD
Plastic Surgery

Breast implants are considered part of a cosmetic procedure, and is usually not covered by health insurance plans. An exception is in the case of a rare entity known as Poland's syndrome, in which the patient has congenital absence of one breast. This is really a form of breast reconstruction. Augmentation for aesthetic reasons is typically not covered by insurance, but may be paid for out-of-pocket, or financed through several agencies your surgeon may refer you to.

Stuart A. Linder, MD
Plastic Surgery
In general, breast augmentation surgery is an elective procedure that is not covered by insurance. Exceptions include scar tissue contracture with hardening around the implant which may be associated with pain and visible distortion of the breast referred to as a Baker IV capsular contracture. Certain plans may cover scar tissue release or removal referred to as a capsulectomy or capsulotomy in order to alleviate pain and deformities of the breast. Breast augmentation for congenital asymmetry or Poland syndrome may also be covered by certain plans. In general, implant replacements in a noncancer patient are not covered by insurance companies.
Tara Whitworth
Nursing
Cosmetic breast augmentation surgery is not covered under insurance. However, reconstructive breast surgery for breast cancer, which often includes breast implants, is generally covered by insurance.
A majority of breast augmentation surgeries are cosmetic or self-pay but there are some exceptions. Learn more from Dr. Michael Howard on behalf of NorthShore University HealthSystem about breast augmentation and insurance.


 
Dr. Elif E. Oker, MD
Medical Toxicology

It depends on the insurance plan and the reason for breast augmentation. In general, breast surgeries to reconstruct breasts that have been altered due to a medical condition like cancer surgery, infection or damaged by trauma are covered. Breast augmentation to alter or enhance appearance (i.e. cosmetic surgery) is generally not covered. There are exceptions so patients seeking this procedure should check with their insurance company.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.