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Will Insurance Pay for Breast Reduction After Lumpectomy?

I am 43 years old and was diagnosed with breast cancer in August of 2008. I had a lumpectomy on my left breast and underwent 6 months of chemo and 30 rounds of radiation. I have had clean checkups for 3 years and am feeling great. I would like to have my right breast (which is at least 2 cup sizes bigger) reduced. I also have double coverage through BCBS. Will insurance pay for this type symmetry reduction?

Doctor Answers (4)

Breast Reduction - Will Insurance Pay for Breast Reduction After Lumpectomy?


Probably.  Insurance companies are required to provide surgical procedures to correct asymmetry resulting from breast cancer surgery and treatment, so there's a good chance this will be "covered."  Of course, what the insurance company indicates is appropriate payment for the surgery may not be the same as what your surgeon feels is adequate, so you'll need to find a surgeon who participates in your insurance plan, or who will accept their allotment as payment, and then work with him or her to authorize your procedure according to the stipulations of your policy.  Based on what you say, I think that your procedure will be covered.

I hope that this helps and good luck,

Dr. E

Web reference:

New York Plastic Surgeon
5.0 out of 5 stars 138 reviews

Breast reduction after lumpectomy


Health insurance companies (including BCBS) are required, by federal law, to cover any procedure done to "restore symmetry" after a patient has surgery for treatment of breast cancer.  So you should have no trouble getting coverage.  All that is left to do is to see a board-certified plastic surgeon for a consultation and have him/her submit the appropriate documentation to you insurance company.

Cleveland Plastic Surgeon
5.0 out of 5 stars 5 reviews

Reduction of contralateral breast after cancer surgery

Every insurance company has its own criteria and BCBS criteria differ from state to state. However, generally, correction of an asymmetry which results from treatment for breast cancer will be covered pursuant to federal law. It is important for your plastic surgeon to obtain a pre certification and in that process to report to the insurance company your history of breast cancer treatment.
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Will Insurance Pay for Breast Reduction Surgery?


Thank you for your question.

Insurance companies are more difficult to work with and each one has it's own criteria for what they will or will not cover.  The first step would be to visit with a surgeon who could help you achieve your goals and see if he/she accepts insurance for this type of surgery.  The doctor would then send paperwork trying to get authorization for the surgery.

In my practice, I send a letter as well as patient photos and any supporting documentation as to why this surgery should be covered by insurance.

Best Wishes.

Web reference:

San Diego Plastic Surgeon
5.0 out of 5 stars 623 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.

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