Will insurance cover any part of my breast reconstruction procedure?

Stuart A. Linder, MD
Plastic Surgery

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. 

Gedge D. Rosson, MD
Plastic Surgery

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)

 

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.

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.
More

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.