Thanks for your question. There are many things about the insurance industry that are hard to figure out. What most companies and policies are pretty clear about, however, is that they don't care what you look like. They may cover the problem you describe if you meet very clearly defined functional issues that require a breathing test to determine. Even then, they will tend to cover functional efforts rather than cosmetic efforts.
Nonetheless, there are things you can do and things we, as plastic surgeons, can do to help your appearance and to help you feel more comfortable. The tools involve implants (both breast and chest wall), a lift or taking fat from somewhere else and using it to improve the contour of your chest.
Find a surgeon you trust who is comfortable with the multiple modalities used in a case like yours. It may take more than one consult to find the right physician.
will not be a covered benefit under insurance unless you have some functional issues that can be proven and documented. Without problems, insurance will not cover it.
I'd like to thank you for addressing your issue with your chest deformity and breast ptosis. It would be best for you to search for a board-certified plastic surgeon in your area to give you the best options. In short, it seems you have a pectus excavatum deformity that in some situations can be treated and covered using insurance. In my practice I see small pectus deformities associated with various breast deformities. This chest deformity can sometimes be camouflaged with a mastopexy (lift procedure) and/or augmentation depending on the size of the chest defect. Other options include fat grafting to smooth out the defect and blend it with the breast tissue. Seek out your plastic surgeon and I'm sure they'll help you.
Insurance does not cover many of these procedures, and they are covering fewer and fewer procedures.
Kenneth Hughes, MD
Los Angeles, CA
It is very unlikely that insurance will cover your asymmetry and ptosis (sagging) even if you have pectus excavatum. You should consult with a plastic surgeon who can explain your options after a physical examination. Best of luck.
Thank you for your question. It is unlikely that your insurance will cover the procedure. You can easily check your policy details by calling your insurance carrier and speaking to the patient representitive. Many of my patients will come to the office "armed" with information about what their individual policy covers and that takes the guessing out of the equation.
Best of luck.
Even if you have Poland's syndrome, which includes the absence of the pectoralis major muscle, the insurance companies will not cover this procedure. They use the standard of functional medical necessity, wherein a breast does not have a function in activities of daily living, in order to deny coverage. You must understand that the only reason they pay for post-mastectomy breast reconstruction is because it was mandated by federal legislation. Asymmetry and sagging are considered symptoms of a cosmetic condition so a lift, augment, or combination of the two would be on a fee for service basis.
Typically insurance companies cover cancer and functional problems with the breasts.
That said you would probably be a candidate for a lift and augmetation. This could be done in a surgery center so you wouldn't have to go to a hospital. Go see a plastic surgeon of your choosing and get an opinion.
The short answer is no. Its possible that some plans could cover surgery but I have not seen this in my practice. I would meet with a few plastic surgeons who take your insurance plan and see what they say. good luck