Depends on the insurance company

Bahram Ghaderi, MD answers: Financing breast reduction through insurance?

If one of my breast is extremely larger than the other. Will insurance cover the procedure? One side is probably a very small A and the other is a very full B, almost C. What's your experience with this?


Bahram Ghaderi, MD
8 months ago

Coverage for breast asymmetry without any symptoms of back and neck pain or other functional disability will likely not be a covered benefit for most insurance companies. However, all insurance companies have different criteria and it really depends on your specific plan. Almost all, however, will consider this a cosmetic procedure and will not be a covered benefit. You can get a consult with a board certified plastic surgeon to go over your question in more detail after a full evaluation.

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A: Functional, reconstructive, and cosmetic plastic surgery

Otto Joseph Placik, MD
8 months ago

Despite what you may consider severe asymmetry, many insurances no longer cover these procedures.

In the past, insurance companies would pay for reconstructive surgery, and this included congenital deformities or severe asymmetry such as yours.

However, recently they have changed their definition to functional surgery. This is interpreted as meaning that only surgery that improves your function will be covered. In your case, this is not functional surgery and would likely NOT be a covered benefit.

If however, you have a MSA or some other form medical compensation, you may have options available for coverage. If you work for a large corporation, you may want to seek the assistance of your human resource department.

In my own practice, I have been disappointed with coverage for these procedures. I can recall an 18 year old girl whose high school counselor, therapist, and pediatrician wrote supportive letters to the insurance carrier who denied their request for coverage.

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