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Breast Implants for Tubular Deformity Covered by Insurance?

Do insurance companies cover breast augmentation for patients with tubular breast deformity?

Doctor Answers (15)

Insurance Coverage For Tuberous Breast Deformities

+2

Although tuberous breast deformities are indeed a "deformity", most insurance companies do not cover this procedure. This condition can create self esteem problems but is not considered a life threatening condition. Insurance companies vary greatly. It is certainly worth contacting your particular company to see if would indeed cover this procedure in your case.

A consultation with a plastic surgeon is recommended. Your surgeon can then determine the appropriate procedure for you. Most surgeons will write a letter with the necessary diagnosis and procedure codes. This can be sent to you insurance company for their evaluation. Good luck.

Sarasota Plastic Surgeon
5.0 out of 5 stars 5 reviews

Tubular Breast Deformity and Insurance

+2

Tubular breast deformity, for our other readers, is when the breast base narrows, the breast tissue is herniated into the nipple areolar complex. This results in large areolas and breasts that resemble a "snoopy" nose. In addition the overall breast size is usually smaller than the contralateral breast.

To correct the deformity an augmentation mastopexy is performed. Radial cuts are made in the breast tissue to allow it to widen, the base is widened, the inframammary fold (crease) is lowered, the areola is reduced in size and the breast is lifted after the implant is placed.

Because there are no functional impairments and the size is usually similar it would be almost impossible in this day and age for insurance companies to cover this cosmetic deformity.

Fairfax Plastic Surgeon
5.0 out of 5 stars 13 reviews

Insurance coverage for tubular breast deformity

+2

Insurance companies typically cover procedures that improve some functional deficit or treat a disease process. Tubular breast deformity is not typically covered as it does not meet either of those criteria. Each insurance company is different, however. If you really want to know, you can discuss having your surgeon send a letter called pre-determination to find out whethere there will be coverage or not. Just know that it is very unlikely. Patients who do have the deformity corrected are very happy and appreciative. There are financing options available with most surgeons which can help also.

Web reference: http://www.stcharlesplasticsurgery.com/html/breast-augmentation.html

Chicago Plastic Surgeon
5.0 out of 5 stars 6 reviews

Tuberous (tubular) breasts are not covered by insurance, but the results can be gratifying.

+2

Tuberous breast conditions are not covered by any insurance plan that I know of. Having said that, the results can be gratifying and certainly worth your investment in the long run. Most patients with tuberous breasts require an implant as well as a circumareolar (also called a donut) mastopexy. Speak to a board-certified plastic surgeon and ask to see tubular breast results.

Web reference: http://www.enhanceyourimage.com/photo-gallery/results.cfm?Category=4

Santa Rosa Plastic Surgeon
5.0 out of 5 stars 11 reviews

Insurance coverage for tubular breast deformity

+2

Every insurance is different in what they cover and what they do not cover. Some genral guidlines are:

1. Does the deformity cause a functional problem?

2. Is the patient young or has the deformity been there for a long time?

3. Is there a non-surgical way to try to take care of the problem and has this been tried.

Ultimately you need to check with your insurance company.

Harrisburg Plastic Surgeon
3.5 out of 5 stars 8 reviews

Tubular breast deformity (constricted) and insurance coveragel

+2

More recently insurance companies have classified condiions as either functional. This means they want to know if surgery will correct a functional problem. Since tubular breasts are not a functional issue, they tend to decline coverage. IF you want to know for sure, have your physician compise a letter of predetermination of benefits.

Web reference: http://www.bodysculptor.com/chicago-breast-enlargement.html

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Tubular Breast Deformity and Insurance Coverage

+1

It is very unlikely that any insurance company will cover procedures to treat a tubular breast deformity. The only breast surgery insurance companies must cover are reconstructive procedures following the treatment of breast cancer (due to a 1998 federal law mandating coverage for mastectomy and post-mastectomy reconstruction).

Houston Plastic Surgeon
4.5 out of 5 stars 101 reviews

Insurance coverage for tubular breasts

+1

Insurance companies vary, so you may want to check your benefits before consulting with a plastic surgeon. However, it's likely that breast implants for tubular breasts will not be covered. Unfortunately, it's hard to get many things covered by insurance even though they may not be cosmetic. Good luck!

Web reference: http://www.DrSchreiberPlasticSurgery.com

Baltimore Plastic Surgeon
5.0 out of 5 stars 61 reviews

Insurance typically does not cover tuberous breast surgery

+1

Hi Jaycee,

Insurance companies typically do not cover surgery to correct tuberous/tubular breast deformity. Although it is a deformity and can affect self-esteem, it is not life threatening. Correction is performed to improve cosmetic results and is not considered medically necessary.

That being said, surgery can make a huge difference in the appearance of the breasts and your self-perception. Surgery generally involves release the tight band at the base of the breast that causes the tubular deformity and placing an implant.

Most board-certified plastic surgeons partticipate with third party finance companies that allow patients to pay for surgery over several months. Best of luck.

Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Tubular Breast Deformity is usually not covered by insurance

+1

Unfortunately, the way insurance companies now define something they will cover is based on the a problem creating a "functional impairment." As tubular breasts cause psychological distress most insurance companies will try very hard to deny any claims related to improving the way a breast looks.

Philadelphia Plastic Surgeon
5.0 out of 5 stars 1 review

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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