Do I Have a Breast Deformity and if Yes, is Reconstruction Generally Covered by Insurance? (photo)

I know not much can be determine from photos alone, but I'm just looking for some feedback. My breasts have been radically different sizes since I was a child (I developed a little early). My left breast has always had a stiff, unnatural feel. If you've ever tugged at your flabby triceps, you will understand the feel. My right is very different and much softer. No matter how much weight I gain or lose, they still behave/look like this. It's just more noticeable when I'm larger. Size B and DD.

Doctor Answers (17)

Health insurance cover of breast surgery

+2

In general health insurance does not cover surgery for asymmetric breasts that developed that way unless some parts are missing like the nipple or the chest muscle (poland's syndrome). Some states like California have a law that expands the definition of reconstructive surgery and mandates health insurance coverage of such surgery. If a lay person looks at a body feature and says that looks abnormal the correction of that feature would be covered in California. Sometimes this can take a bit of back and forth between you and the insurance company and frequently it requires review by a third party before being cleared.

Your left breast is less than half the size of your right so the California state expanded definition of reconstructive surgery would apply. I do not know what state you live in but it is worth checking into if it can save you some money. If you have a restrictive HMO health plan this may be irrelevant as they would not cover any surgery with non-participating doctors.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.


Los Angeles Plastic Surgeon

Breast Deformity and Breast Surgery?

+2

Thank you for the question and pictures. The pictures do demonstrate significant breast asymmetry and it is likely that you will benefit from breast surgery at some point. Factors that should be considered are your age, achieving a long-term stable weight, plans for pregnancy and general life circumstance considerations.

 Generally speaking, most health insurances will not cover this type of surgery ( based on recent experience), but always best to check with your specific insurance company for precise information.

 When the time is right, seek consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients in your situation.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

You have asymmetry

+2

What you have is asymmetry and it can be corrected.  You should have your surgeon check to see if you health insurance will cover the surgery.

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 42 reviews

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Asymmetric Breasts & Insurance

+2

It appears from your photos that you have asymmetric breasts, more so than what is common.  You can definitely improve your appearance but unfortunately, insurance will most likely not cover it as it's an aesthetic issue not a health issue, but you can always check with your insurance, it could be worth a try.  ac

Angela Champion, MD
Newport Beach Plastic Surgeon
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Breast Asymmetry and Insurance Coverage.

+2

Dear Irish89,  Every woman has some asymmetry between her right and left breasts, some more than others.  You do have a significant degree of asymmetry but unfortunately, this type of correction is usually not covered by insurance companies.  The only way to be absolutely certain to is contact your insurance carrier or to read through your insurance plan very carefully.  If your insurance is through a large employeer, many companies will have a Human Resources Department who can assist you with your search.  That being said, it is very rare that the surgery you need would be covered by any insurance company.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

Do I Have a Breast Deformity and if Yes, is Reconstruction Generally Covered by Insurance? (photo)

+2

Yes you have genetic/congenital breast asymmetry. In MOST cases this is NOT covered by your health insurance. Best to call your insurance obtain a case manager to discuss the steps needed to obtain any coverage, if possible (I doubt though).

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Breast asymmetry covered?

+2

You indeed do have a deformity.  While most women have some degree of asymmetry in their breasts, your's is more than two standard deviations from the average. Unfortunately, most insurance companies don't cover this.  You would have to check your policy and probably talk to a customer service representative.  It can be fixed with a combination of reduction on the right and augmentation on the left. Good luck!

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
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Breast asymmetry

+2

Yes, it is quite evident that you have a breast asymmetry, while this can be improved, it is not covered by insurance.

Steven Wallach, MD
Manhattan Plastic Surgeon
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Breast Asymmetry

+2

You have severe breast asymmetry that requires a breast lift or reduction on the right side and breast augmentation on the left side. You can try to submit the case to your insurance as a congenital deformity but most likely it will be denied.

 

Good luck!

Tal T. Roudner, MD, FACS
Coral Gables Plastic Surgeon
5.0 out of 5 stars 77 reviews

Breast asymmetry

+2

Hi - Based on your photos, you have some significant breast asymmetry.  Usually, this can be improved significantly with surgery.  Typically, the smaller side is augmented, and the larger side is reduced or lifted.

In my experience, the insurance companies rarely pay for this.  They see it as "cosmetic", even though I totally understand that you just want to look normal.

Give your insurance company a call, and see what they say.

Thomas Fiala, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 25 reviews

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.