Breast Implants for Tubular Deformity Covered by Insurance?

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

Doctor Answers 17

Insurance coverage for tubular breast deformity

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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.

Chicago Plastic Surgeon

Tuberous (tubular) breasts are not covered by insurance, but the results can be gratifying.

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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.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Insurance coverage for tubular breast deformity

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Every insurance is different in what they cover and what they do not cover. Some genral guidlines are:

1. Does the deformity cause a functional problem?

2. Is the patient young or has the deformity been there for a long time?

3. Is there a non-surgical way to try to take care of the problem and has this been tried.

Ultimately you need to check with your insurance company.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Tubular breast deformity (constricted) and insurance coveragel

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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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Usually not

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

Breast implants for tubular breast deformity covered by insurance?

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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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Tubular Breast Deformity and Insurance Coverage

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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).

Insurance Coverage For Tuberous Breast Deformities

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Although tuberous breast deformities are indeed a "deformity", most insurance companies do not cover this procedure. This condition can create self esteem problems but is not considered a life threatening condition. Insurance companies vary greatly. It is certainly worth contacting your particular company to see if would indeed cover this procedure in your case.

A consultation with a plastic surgeon is recommended. Your surgeon can then determine the appropriate procedure for you. Most surgeons will write a letter with the necessary diagnosis and procedure codes. This can be sent to you insurance company for their evaluation. Good luck.

James H. Schmidt, MD (retired)
Sarasota Plastic Surgeon

Tubular Breast Deformity and Insurance

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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.

Insurance coverage for tubular breasts

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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!

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.