Is Hypoplastic Breast Reconstruction Covered Under Insurance?

Is Hypoplastic Breast Reconstruction Covered Under Insurance?

Doctor Answers (7)

Is hypoplastic breast reconstruction covered by insurance?

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Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Insurance coverage for breast hypoplasia

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Unfortunately most insurance carriers consider this a cosmetic procedure now;  I occasionally got this covered a number of years ago, but it is routinely denied now.  If the correction involves a component of soft tissue reconstruction (e.g. a flap reconstruction) it might be that a pre-determination would be worthwhile, but certainly no guarantees could be made that this would afford insurance coverage.

Jerry Lugger, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 2 reviews

It may be covered by the insurance if need more than implant for augmentation

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If you have true breast deformity ,your insurance may cover it if requires reconstruction rather than augmentation .  Depending on your insurance company and their restrictions, reconstruction may be covered. The most common diagnosis that covered is Poland's syndrome which is complete absence of the breast tissue.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 54 reviews

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Hypoplastic breast insurance coverage

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Occasionally a onesided hypoplastic breast may be covered by generous insurance carrier. Visit with a local plastic surgeon for an evaluation and if deemed appropriate a predetermination letter can assess the possibility of your carriers coverage. Good luck

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 3 reviews

Is Hypoplastic Breast Reconstruction covered by insurance?

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Hypoplastic breast or more commonly know as small breasts are treated by breast augmentation and is a procedure not covered by health insurance!

Tal T. Roudner, MD, FACS
Coral Gables Plastic Surgeon
5.0 out of 5 stars 80 reviews

Hypoplastic breasts

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Small or hypoplastic breast surgery to make them larger is called a breast augmentation and is not covered by insurance.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Hypoplastic breast

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Hypoplastic breast or small breast is not covered by isurance. It is a cosmetic procedure.

Samir Shureih, MD
Baltimore Plastic Surgeon

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.