Intracapsular Rupture & Insurance?

Just had an MRI which revealed Intracapsular Rupture from a saline implant 8 yrs ago. From what I can tell it is a rupture that is still held within the capsule that was formed around the implant? It must either be new or a slow leak as I can't tell a difference. If surgery is needed ( I don't know if it is something serious or not) would my insurance be more likely to cover it if it was originally covered for the implant?

Doctor Answers (11)

Intracapsular Rupture & Insurance?

+1

It is, in general, unlikely that insurance would cover this surgery.  Removal of implants may be "covered" (which is not the same as a given plastic surgeon accepting what the insurance company pays as payment for the surgery).  However, there's another issue; I wonder whether the MRI is accurate?  Normally, a saline implant deflates to the point that it's clear whether or not it's leaking.  Why did you have the MRI? 

Either way, you should speak with your PS to find out what to do next.  You will most likely need to be seen in person and, at that point, you can find out how best to contact your insurance company, etc.

Dr. E


New York Plastic Surgeon
5.0 out of 5 stars 148 reviews

Breast Implants and Insurance

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Breast implant surgery is never covered by insurance except for breast reconstruction. Some insurance companies do cover complications of breast implant surgery. Some just cover removal of an implant but not replacement. Assuming your surgeon takes insurance (which not all plastic surgeons do) they could write a letter of medical necessity to the insurance company to see what is covered. Since your implant was only 8 years ago, I believe that most implant companies warranty the inmplants for up to ten years. they will replace the implant and also give some money towards the operation to replace the implant. Check with your implant company (usually Mentor or Allergan) to see what will be covered by them. If you do not know your implants, your previous surgeon will know. Good luck.

William LoVerme, MD
Boston Plastic Surgeon
4.5 out of 5 stars 19 reviews

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Insurance coverage for breast augmentation revision

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It sounds like you may have had implants placed for breast cancer, if so, the rupture or deflation would likely be covered by your insurance.

W. Tracy Hankins, MD
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Rupture saline implant

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Saline implant deflation is what you have.  It may be a rupture, of sorts, or a valve leak.  It is inoquous except for the fact that you are likely assymetric in your breast size now.  Coverage from your insurance is unlikely.

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Talmage J. Raine, MD
Chicago Plastic Surgeon
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Saline implant rupture

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I am not sure why you needed an MRI to tell you if a saline implant ruptured. If your breast is flatter now, then the implant deflated.  

Steven Wallach, MD
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Breast implant rupture occasionaly is covered by insurance

+1

Each insurance plan has their own definition of what is covered.  A few will cover the removal of breast implants (or implant material) but almost never cover the cost of replacement unless they were placed for reconstruction purposes.  On a separate note, intracapsular rupture of a saline implant does not make a lot of sense from a diagnostic standpoint.  If a saline implant ruptures, the fluid will be Intracapsular (contained within the scar tissue envelope surrounding the implant) briefly but then will be absorbed by the body.  The result is a "flat tire"; that is to say the breast on the ruptured side will deflate.  Slow leaks can occur, but the time frame is rarely more than a few weeks.                                      

Michael S. Hopkins, MD
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Health insurance may not cover implant rupture

+1

As a rule saline implants lose volume rather quickly after rupture so you just might have a false reading on the MRI. Medical insurance will often deny coverage for implant removal if your implants were placed for cosmetic reasons. Implant companies will often have a replacement warranty so you might check you implant papers you received after augmentation. On a bright note saline implants are very easy to remove at a low cost if you find you just must remove them.

Peter E. Johnson, MD
Chicago Plastic Surgeon
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Ruptured saline implant and insurance coverage

+1

A ruptured saline implant is usually not considered a surgical or medical emergency, and is not usually covered by health insurance.  You should check you policy to be sure however.

On the other hand, the implant manufacturers do offer extended type of warranties that you have to pay for within 30 days of initial surgery ($100), that cover ruptures for up to 10 years.  You should have paperwork from your surgery to tell you that information.  If you can't find the paperwork, contact your ps who can check with the company.

Scott E. Kasden, MD
Dallas Plastic Surgeon
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Insurance does not cover failure of an implant after breast augmentation but the manufacturer will.

+1

Breast implant manufacturers have different warranties but most will cover a portion or even all of the implant replacement if it occurs within specified period of time.

Vincent N. Zubowicz, MD
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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.