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Will Insurance Pay for Inverted Nipples with Sagging Breast?

Doctor Answers (10)

Correctiono of inverted nipple

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The correction of inverted nipples is not usually a covered procedure.  You can call your insurance company and ask to speak with a claims representative and make the inquiry yourself.  The surgery for an inverted nipple is usually very simple and can be performed under local anesthesia as an outpatient. 


Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Inverted Nipples/Mastopexy and Insurance Coverage?

+1

Thank you for the question.

Correction of inverted nipples and/or breast lifting surgery are not procedures generally covered by health insurance plans.

Some information regarding inverted nipple  surgery may be helpful...

Inverted nipples can cause functional problems for women and emotional concerns. An inverted nipple can look flat or a slit like depression or hole at the normal nipple location. There are different degrees of inverted nipples possible. Whether a patient is a candidate for correction of inverted nipples  depends on the  extent of the problem.

Usually correction of the inverted nipples involve division  of the lactiferous (milk ducts). The risks  of the procedure include potential loss of sensation, inability to breast-feed, recurrence of the asymmetry and the potential need for further surgery.

My advice to patients go something like this...  If the nipple is permanently inverted and does not evert  with stimulation, then it is a useless nipple  when it comes to sensitivity and/or breast-feeding. In these  cases correction of inversion is indicated (because the potential gains outweigh the risks outlined above).  On the other hand, if the nipple does evert  spontaneously with  or without stimulation,  then I am more reluctant to perform the procedure given that the risks may outweigh the potential benefits.  At that point, the decision is the patient's to make after careful consideration.

I hope this helps

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 707 reviews

Insurance does not pay for inverted nipples or breast lifts

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Both these diagnoses are considered cosmetic and insurance will not pay for either surgery. This would be a fee for service procedure as there is no functional necessity involved.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

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Insurance rarely pays for cosmetic surgery

+1

It is very rare for any health insurance to pay for cosmetic surgery. Inverted nipples that occur with ptosis (sagging breast) may be nicely corrected with a breast lift or Mastopexy. For patients undergoing breast reconstruction, insurance companies will pay for a Mastopexy on the opposite side to correct for asymmetry. Other than this situation, it is unlikely that they would pay for the procedure you are inquiring about. Good luck.

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 26 reviews

Insurance and inverted nipples and sagging breasts

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It is hard enough to get a formal breast reduction covered by insurance. I would be extremley surprised if an insurance company would cover basically a breast lift and inverted nipple repair.

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

VIDEO: Mastopexy (breast lift) and inverted nipple repair: Insurance coverage

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In my experience, insurance companies do not pay for breast lift procedures nor do they cover inverted nipple repair unless you have a liberally interpreted medical savings account plan.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Medical Insurance Does NOT Pay for Cosmetic Surgery

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Medical Insurance plans do not pay for Cosmetic Surgery (intended to improve a normal appearance). Inmany cases, they have a hard time paying for Reconstructive Plastic Surgery (intended to either return appearance or function back to normal from where birth defects, disease on injury have put them). A sagging breast does not fall in this category and if you want to make them more perky and attractive you will have to personally fully pay for it. Dr. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

Breast sagging is a cosmetic problem.

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Sagging of the breast is call ptosis. While it may make you unhappy this condition does not cause risk to your life or health. As such it is a cosmetic problem and health insurance does not cover cosmetic surgery.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 32 reviews

You own the insurance

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If your insurance covers cosmetic problems  -- then it might pay 00 but dont expect it to. Call the company and ask them.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Inverted nipples

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Not usually as this is a cosmetic problem. There is also a difference between nipples that cannot be teased out and nipples that can be pulled out but then retract. Often the sagging of the breast and the lost of subareolar tissue support will cause a nipple to invert. Restoration of volume with an implant may provide enough support for the nipple to evert again.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 7 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.