Breast Implants for Tubular Deformity Covered by Insurance?

Question

Do insurance companies cover breast augmentation for patients with tubular breast deformity?

Otto Joseph Placik, MD · Answer

More recently insurance companies have classified condiions as either functional. This means they want to know if surgery will correct a functional problem. Since tubular breasts are not a functional issue, they tend to decline coverage. IF you want to know for sure, have your physician compise a letter of predetermination of benefits.

Jerome Edelstein, MD · Answer

You would have to ask your insurance provider, however in general tubular breast correction with implants is not covered by insurance.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  This is usually considered an aesthetic procedure to correct tuberous/constructed breasts, since there is no functional deficit from this...mainly cosmetic appearance.  The standard procedure would be placement of an implant (or tissue expander, depending on the lower pole of your breast) as well as a circumareolar breast lift.  These modalities would correct the issues with tuberous breast: constricted breast at the inferior pole, via breast prosthetic; scoring of the tissue to release the bands; lowering the inframammary fold; correcting the herniation of breast tissue into the areolae; and decreasing the overall size of the areolae.  These are the hallmarks of tuberous breasts.  You could likely get great results with an implant and possible breast lift.Consult with a plastic surgeon well-versed in breast surgery and discuss your goals and expectations.  S/he will then be able to examine and discuss the various options and assist you in deciding which option will be the right one for you.  Hope that this helps!  Best wishes for a wonderful result!

Jeffrey E. Schreiber, MD, FACS · Answer

Insurance companies vary, so you may want to check your benefits before consulting with a plastic surgeon. However, it's likely that breast implants for tubular breasts will not be covered. Unfortunately, it's hard to get many things covered by insurance even though they may not be cosmetic. Good luck!

Sam Jejurikar, MD · Answer

Hi Jaycee,
Insurance companies typically do not cover surgery to correct tuberous/tubular breast deformity.  Although it is a deformity and can affect self-esteem, it is not life threatening.  Correction is performed to improve cosmetic results and is not considered medically necessary.
That being said, surgery can make a huge difference in the appearance of the breasts and your self-perception.  Surgery generally involves release the tight band at the base of the breast that causes the tubular deformity and placing an implant.
Most board-certified plastic surgeons partticipate with third party finance companies that allow patients to pay for surgery over several months.  Best of luck.

C. Bob Basu, MD, MPH, FACS · Answer

It is very unlikely that any insurance company will cover procedures to treat a tubular breast deformity. The only breast surgery insurance companies must cover are reconstructive procedures following the treatment of breast cancer (due to a 1998 federal law mandating coverage for mastectomy and post-mastectomy reconstruction).

Christopher L. Hess, MD · Answer

Tubular breast deformity, for our other readers, is when the breast base narrows, the breast tissue is herniated into the nipple areolar complex.  This results in large areolas and breasts that resemble a "snoopy" nose. In addition the overall breast size is usually smaller than the contralateral breast.
To correct the deformity an augmentation mastopexy is performed.  Radial cuts are made in the breast tissue to allow it to widen, the base is widened, the inframammary fold (crease) is lowered, the areola is reduced in size and the breast is lifted after the implant is placed.
Because there are no functional impairments and the size is usually similar it would be almost impossible in this day and age for insurance companies to cover this cosmetic deformity.

Steven Wallach, MD · Answer

Tuberous breast deformity is not usually covered by insurance. Insurance companies usually cover reconstruction for functional problems. Unfortunately they do not think of tuberous breast deformities in the same vein.

Bahram Ghaderi, MD · Answer

Insurance companies typically cover procedures that improve some functional deficit or treat a disease process. Tubular breast deformity is not typically covered as it does not meet either of those criteria. Each insurance company is different, however. If you really want to know, you can discuss having your surgeon send a letter called pre-determination to find out whethere there will be coverage or not. Just know that it is very unlikely. Patients who do have the deformity corrected are very happy and appreciative. There are financing options available with most surgeons which can help also.

Francisco Canales, MD · Answer

Tuberous breast conditions are not covered by any insurance plan that I know of. Having said that, the results can be gratifying and certainly worth your investment in the long run. Most patients with tuberous breasts require an implant as well as a circumareolar (also called a donut) mastopexy. Speak to a board-certified plastic surgeon and ask to see tubular breast results.

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