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Insurance Coverage for Breast Lifts with Severe Ptosis?

I'm just curious- do insurance companies ever cover breast lifts for women with severe ptosis? For example, although my breasts don't look that big under clothes (at least in my opinion-they lack volume), they are a 32L and the nipple points down/is on the very bottom. They actually reach my waist.. I'm 23 and breastfeeding. I actually get a rash sometimes on my stomach from where my nipple touches when they leak breast milk. That's how bad they are. I don't want a lift now, just curious.

Doctor Answers (9)

Reduction

+1

The insurance companies do provide coverage for breast reductions if a certain volume of breast is removed and if you are within a normal weight range


New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast Lifting and Insurance Coverage?

+1

Generally speaking, insurance companies may provide coverage for patients seeking breast reduction surgery, but not breast lifting surgery. For example, many health insurances will have specific requirements as to how much breast tissue  must be removed in order to have the procedure "covered”.

 If you are considering breast surgery, it would be in your best interests to  wait at least 3 to 6 months after you have stopped breast-feeding before proceeding.

 Best wishes.

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

Insurance coverage for breast lift

+1

Usually a breast lift is not covered but I have found that after weight loss surgery and having the rash you describe it is sometimes covered.  You would have to check with your insurance company and your individual policy to find out.  It is better to know this up front but remember they always say in the letter from the insurance company that approval is no guarantee of payment.  Have a blessed day!

Thomas P. McHugh, MD
Houston Plastic Surgeon
4.0 out of 5 stars 5 reviews

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Insurance coverage

+1

Most insurance companies cover the cost of breast reduction but not a breast lift, no matter what kind of problems they cause for you.  Sometimes they will consider an issue such as skin rash, so you can always ask them.  But your chances of having it covered are small.  Sorry.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 7 reviews

Not that I know of

+1

I have never heard of an insurance company paying for a breast lift except when a patientb has a mastectomy and reconstruction on one side for symmetry.

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Insurance coverage for breast lift

+1

I have never seen an insurance company cover a breast lift, but that does not mean it is impossible.  The best thing you can do is see a board-certified plastic surgeon and have him or her submit your case to the insurance company.  Good luck!

Naveen Setty, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 18 reviews

Breast lift coverage with insurance

+1

You could certainly try, but I have never seen insurance cover a breast lift in my career.  Although breast lifts and breast reductions are essentially the same operation (the difference being that breast tissue is removed during a breast reduction), insurance companies see a breast reduction as a functional problem and a breast lift as a cosmetic problem.  They will only cover functional problems.  If you can somehow convince them that this is indeed a functional issue then you might have a chance but I would be very surprised if they covered it.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 9 reviews

Breast Lift Covered by Insurance?

+1

   I have never seen breast lift covered by insurance, and even breast reduction is approved less and less.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 180 reviews

Nsurance Coverage for Breast Lifts with Severe Ptosis?

+1

It has been many years since I have heard of coverage for a lift in the US. The carriers pretty much have defined this as a cosmetic procedure, and for the overwhelming percentage of cases it is so. 

Severe and recalcitrant intertrigo (rash under the breast), having failed multiple trials at medical therapy might impress the insurer, but that does not sound like the case here. Thanks, and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 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.