Is breast reconstruction surgery covered by insurance?

Heather L. Karu, MD
Plastic Surgery
If breast reconstruction surgery is needed to restore symmetry after a partial or full mastectomy, can you really call the procedure merely cosmetic? In this video, Dr. Heather Karu discusses a patient's legal rights when it comes to reconstructive surgery.
Ajay K. Sahajpal, MD
Transplant Surgery
It generally isn't covered for purely cosmetic purposes, unless part of a cancer operation to remove the breast and reconstruct.
Mark Sisco, MD
Plastic Surgery
Federal law has mandated that insurance companies cover patients undergoing reconstruction breast cancer surgery or risk reducing breast surgery. Learn more from Dr. Mark Sisco on behalf of NorthShore University about breast reconstruction surgery.
Intermountain Healthcare
Administration
The Women's Health and Cancer Rights Act (WHCRA) of 1998 does include requirements for insurance companies to cover reconstruction of a breast defect following a mastectomy.  It also provides for reasonable correction of asymmetry.  The caveat, however, is that the act exempts government plans from this requirement (such as Medicare and Medicaid).  My personal experience, however, is that Medicare is quite cooperative in assisting women with reconstruction following mastectomy despite not being legally bound to such.
Stuart A. Linder, MD
Plastic Surgery
Both federal and state laws require that breast cancer reconstruction be covered by health insurance.  This may include not only the affected breast but the contralateral breast in order to regain a form of symmetry.  In general, breast cancer reconstructions may require multiple stages and each of these stages should be covered by your insurance.  Stages can include tissue expanders, breast implant placement status post expansion, autologous tissue transfer, and nipple-areolar reconstruction.
Erik A. Hoy, MD
Plastic Surgery
Since 1998, Congress has mandated universal insurance coverage for breast reconstruction after removal of breast cancer.  This even includes staged procedures such as the filling of adjustable breast implants or reconstruction of the nipple.  It also covers cases in which a breast lift is required in a normal breast in order to better match a reconstruction on the cancerous breast.  Now, new legislation in New York state will require doctors and healthcare centers to review reconstruction options with patients prior to the resection of their breast cancer.  If the initial center does not perform reconstructions, the patient must be referred to one that does.  These laws help protect a patient's access to reconstructive surgery after breast cancer removal.

Michele A. Manahan, MD
Plastic Surgery

Federal and state laws require insurance companies to pay for all or part of the cost of breast reconstruction at any time after removal a patient's breast tissue. This includes any surgery required on the opposite breast for symmetry.

Continue Learning about Breast Reconstruction Surgery

Breast Reconstruction Surgery

Breast Reconstruction Surgery

Women who have aggressive forms of breast cancer, or who are at high risk of developing the disease, sometimes choose to have a mastectomy, the surgical removal of one or both breasts. Some patients may then choose to have surgery ...

to reconstruct their breasts to restore their form and shape. During this procedure, doctors can replace any skin, breast tissue or a nipple that they may have removed during the surgery. (If you still need radiation therapy after your mastectomy, your doctor may suggest you wait for reconstructive surgery until after you finish treatment.) Breast implants, filled with either silicone or saline, can be used to reshape your breast, or you can even use your own tissue, a procedure called flap surgery. Both breast implants and flap surgery are complex procedures, each with their own risks; they may require second surgeries to position the breasts correctly. Most insurance companies will cover this type of reconstructive surgery. Learn more about breast reconstruction with expert advice from Sharecare.
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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.