Uneven Breasts - Will Insurance Cover Implants?

Question

I am 21 years old, two years ago I had a fine needle aspiration on my right breast. Throughout the two years I have noticed that my right breast has gotten drastically smaller. Now my breasts are very noticeably uneven. My left breast is about a full c and my left is almost a full a. I am looking to get implants to make my breasts at least somewhat even. What are the chances it will get covered by insurance?

Young R. Cho, MD, PhD · Answer

Thank you for your question. Breast asymmetry is very common, particularly size asymmetry. If you are looking to decrease the asymmetry from one breast to another, then you have several options:
1) You can reduce the larger breast with liposuction or a traditional breast reduction technique
2) You can enlarge the smaller one with fat grafting or an implant
3) You can enlarge both but use different size implants
4) A lift procedure may also be needed to help address differences in shape, nipple position and areolar size.
Insurance coverage for asymmetry coverage may be challenging as insurance companies don't usually cover implants unless it is for cancer reconstruction.  They may cover breast reduction of the larger size if there are specific medical concerns like back pain, neck pain, etc...  They will require extensive documentation and it may still not be covered.
I would visit with a board certified plastic surgeon to discuss your options in more detail.

Richard J. Bruneteau, MD · Answer

Breast
asymmetry is an extremely common problem amongst women.In most cases, this is relatively minor and
women aren’t bothered by it.Occasionally,
it can be severe and treatment is necessary.A multitude of options can be used to treat this problem.These may include breast reduction, breast
lift, breast augmentation, or various combinations of these procedures.Unfortunately, most insurance
companies only cover the expense of treating breast asymmetry when it’s
associated with breast cancer.They view
this type of procedure as purely cosmetic.Rarely, insurance carriers will cover the expense of these procedures
when they’re associated with functional impairment.This usually requires going through the prior
authorization process to establish medical necessity.This is usually always unsuccessful.If you’re considering correction of
breast asymmetry, it’s important that you meet with a Board-certified plastic
surgeon that can discuss your aesthetic goals in greater detail and determine
which option is best for you.When this
approach is taken, the results of surgical intervention are usually excellent
and levels of patient satisfaction are extremely high.

Lewis Albert Andres, MD · Answer

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.   Insurance will not cover for this reason.  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. 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!

Scott C. Sattler, MD, FACS · Answer

Althought the breast assymetry you describe is concern to you, and is temporally related to the FNA that you had done- I doubt an insurance company would pay for breast implants to address what is a purely cosmetic issue. Insurance companies do not cover cosmetic procedures. Breast augmentation can be done to address the assymetry that you do have, but plan to pay out-of-pocket for it.

Raj S. Ambay, MD · Answer

By law, insurance companies must pay for implants used in breast reconstruction associated with cancer. In fact, before 1998 even breast cancer reconstruction was not universally covered because insurance executives did not think that having breasts were "medically necessary" . It took a law to make that happen. Everything else will be considered cosmetic including asymmetry not related to cancer and thus not be covered. Every insurance is different with the exception that they profit by not paying for health care services. There is a perverse incentive to collect premiums from consumers and not pay for care. You have to be your strongest advocate for your health. As a consumer, call your insurance company and make your case. I bet you doctor will arm you with all the medical documentation.

Steven Wallach, MD · Answer

Unfortunately, insurance companies do not cover surgery for breast augmentation even with significant asymmetry.  Good luck.

Barry L. Eppley, MD, DMD · Answer

Despite your feeling that there is a medical reason for your breast asymmetry, I would say that there is no chance that insurance would cover breast implants, otherwise known in CPT coding as breast augmentation. For insurance to cover breast implants, it would have to be done for reconstructive purposes which insurance views as cancer-based. Only in cases of lumpectomies or mastectomies will insurance cover breast reconstruction with implants.

Steven Turkeltaub, MD · Answer

Asymmetery of the breasts is the norm - rarely are women's breasts identical. Even having undergone a fine needle biopsy of your breast, probably no insurance company today would cover this as a reconstructive procedure. Therefore, in order to improve the appearance and symmetry of your breasts, this would have to be paid out of pocket as a cosmetic procedure.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Following a medically necessary breast procedure, it is unlikely but possible to have your insurance company cover your surgery. Your asymmetry needs to be documented by photography and have your plastic surgeon send it in for a preauthorization. If your assymetry is dramatic, it won't hurt to give it a try.

George J. Beraka, MD (retired) · Answer

HI.

	Twenty years or so ago I wrote a textbook chapter on breast asymmetry, and because of that, have treated a lot of women with this problem. And we cannot get insurance coverage.  It is a congenital deformity, and it should be covered, but unfortunately it is not.

	You can try going to the plastic surgery clinic of a teaching hospital, where you usually get safe, inexpensive care.

Uneven Breasts - Will Insurance Cover Implants?

Answers (10)

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