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Breast Implants for Tubular Deformity Covered by Insurance?

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

Asked 28 months ago by jaycee79 in texas

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Tubular breast deformity (constricted) and insurance coveragel

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. see video

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Insurance Coverage For Tuberous Breast Deformities

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... more

James H. Schmidt, MD

Sarasota Plastic Surgeon

ASAPS ASPS

Tubular Breast Deformity and Insurance

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... more

Doctor's Website

Christopher L. Hess, MD

Fairfax Plastic Surgeon

ASPS

Insurance coverage for tubular breast deformity

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... more

Bahram Ghaderi, MD

Chicago Plastic Surgeon

ASAPS ASPS

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

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.

Francisco Canales, MD

Santa Rosa Plastic Surgeon

ASAPS ASPS

Insurance coverage for tubular breast deformity

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.

John P. Stratis, MD

Harrisburg Plastic Surgeon

ASAPS ASPS

Tubular Breast Deformity and Insurance Coverage

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).

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C. Bob Basu, MD

Houston Plastic Surgeon

ASPS

Insurance coverage for tubular breasts

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!

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Jeffrey E. Schreiber, MD

Baltimore Plastic Surgeon

ASPS

Insurance typically does not cover tuberous breast surgery

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... more

Sam Jejurikar, MD

Dallas Plastic Surgeon

Tubular Breast Deformity is usually not covered by insurance

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.

Sean Wright, MD

Philadelphia Plastic Surgeon

ASPS

Tubular Breast Coverage

In medicine you can never say never nor always, but it is extremely unlikely that a tubular breast deformity correction would be covered by your insurance. This is a cosmetic rather than medical deformity. You can always ask your ins. co., but you would probably be wasting your time.

John Whitt, MD

Louisville Plastic Surgeon

ASAPS ASPS

Is surgical correction of tubular breast deformity covered by insurance?

No. Like many other non life threatening deformities it is regard as a purely cosmetic condition and its correction is NOT paid for by any medical insurance company that I am familiar with.

Peter A. Aldea, MD

Memphis Plastic Surgeon

ASPS

Insurance won't cover tubular breast deformities

Because a person can survive and live with a tubular breast deformity, the insurance companies would not consider this to be medically necessary and it is therefore cosmetic. As such, they won't cover it's correction.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

Tuberous breast deformity and insurance coverage

Tuberous breast deformity is not usually covered by insurance. Insurance companies usually cover reconstruction for functional problems. Unfortunately they do not think of tuberous breast deformities in the same vein.