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Will Insurance Cover Implant Exchange under Cancer Mastectomy Reconstruction? Is Procedure Realistic?

asked 1 year ago by Liz9876
Latest answer by Christine Sullivan, MD
Question viewed 589 times
Tags: wrinkles, saline implants, silicone implant, breast cancer, exchange, implant, insurance, mastectomy

I Had Dbl Mastectomy W/ Reconstruction (Saline Implants). My Left Breast Has Always Had a Couple of Wrinkles/ Bubbles. I would like to exchange my implants for silicone. (I am now seeing some significant dimpling etc. in my left breast,not there before). Would my insurance be required to pay for this under cancer mastectomy reconstruction? How realistic is this to do? Thank you.

7 answers to Will Insurance Cover Implant Exchange under Cancer Mastectomy Reconstruction? Is Procedure Realistic?

+2

Insurance Coverage for Breast Cancer Reconstruction

Your implant exchange should be covered by your insurance.   Of course, you need to ultimately check with your insurance carrier.  But given your history of breast cancer/mastectomy, it has been my experience that patients get this procedure covered by their insurance.
C. Bob Basu, MD

Houston Plastic Surgeon

www.basuplasticsurgery.com

+1

Breast Reconstruction

The Women's Health and Cancer Rights Act (WHCRA) of 1998 is a federal law that that requires health insurance companies and self-insured group health plans that cover mastectomies to also provide benefits for mastectomy-related services, including breast reconstruction surgery. WHCRA is also known as Janet's Law, named after Janet Franquet, who was denied reconstructive surgery after a mastectomy in 1997. If you're receiving health insurance benefits in connection with a... more
Christine Sullivan, MD

Columbus Plastic Surgeon
+1

Secondary breast reconstruction and insurance coverage

In theory all surgery related to breast reconstruction should be covered in separate state legislation (approx 13 states) and more recently by Federal legislation.  Having said that the climate for insurance reimbursement is becoming less predictable.  The key in a case such as yours is to have your surgeon precertify the surgery after providing clear documentation of the indications for your procedures. In answer to how realistic is it to do an exam would be essential to... more
Jay W. Birnbaum, MD

New York Plastic Surgeon
+1

Implant exchange for breast cancer

If you are having implant problems after you had breast reconstruction for cancer, then it should be covered.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Implant Exchange Coverage in Breast Cancer Patient

This procedure should be covered by your insurance carrier according to federal law.   You will see improvement in the wrinkling and dimpling with silicone implant exchange, but not complete resolution.   Fat grafting is gaining acceptance as an adjunct to implant breast reconstruction to give a softer more natural look.   I wish you a safe and healthy recovery.
Paul S. Gill, MD

Houston Plastic Surgeon
+1

Breast Reconstruction implant replacement

A federal mandate in 1996 established coverage for breast cancer patients for surgeries related to their breast reconstruction as well as symmetry operations on the contralateral/uninvolved breast. An implant exchange should be covered, but I always recommend that patients contact their insurance provider to verify within their own plan. Changing from saline to silicone implants will provide a much different feel to the implant. It is also likely to improve your complaints of wrinkling and... more
David Bogue, MD

Boca Raton Plastic Surgeon

www.drbogue.com

+1

Insurance SHOULD Cover Implant Change Post-Mastectomy

By federal law, your insurance company is required to cover anything related to your breasts once you are diagnosed with breast cancer, including implant changes.  As long as your surgeon includes the history of breast cancer in the diagnosis, then they should cover it.  The silicone implants are much more natural feeling, and when you are feeling nothing but some skin, thin muscle, and implant, you want it to feel as natural as possible.  I hope this helps. more
Christopher V. Pelletiere, MD

Barrington Plastic Surgeon

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