I'm not sure if this is the correct website for this question, but I was wondering how to get insurance to pay for some or all of the cost of breast augmentation surgery to correct massively asymmetrical breasts. My right breast is a large C-cup, possibly D, and my left breast is a small B-cup, possibly A. A visited a plastic surgeon who recommended breast augmentation surgery, but my insurance company will only pay for reconstructive cosmetic surgery. Thank you for your advice.
Getting Insurance to Pay for Augmentation of Massively Asymmetrical Breasts
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Doctor Answers 9
Breast asymmetry options and insurance coverage
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.
Insurance generally does not cover breast augmentation
Breast Asymmetry and Insurance
Breast asymmetry correction is generally considered to be a cosmetic procedure. Insurance would typically not cover the procedure.
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Insurance to cover breast asymmetry
In general insurance companies do not cover the correction of breast asymmetry. You might be able to get them to cover a unilateral breast reduction, but they will not cover augmentation. If you wanted to pursue a reduction, your plastic surgeon's office could advise you how to proceed. The patient usually needs to submit verification that the large breast is causing symptoms such as back pain. If you want to pursue this, ask your plastic surgeon who in his/her office helps with getting approval for this. Some communities also have "insurance consultants" who help patients with this.
Tracy M. Pfeifer, MD, MS
Breast augmentation and symmetry correction won't be covered by insurance
Unfortunately, serious asymmetry is still something you can survive and live with and as such, your insurance won't be willing to provide coverage. Try to save for the necessary procedure to improve the situation but don't place your hope on getting coverage as it will just leave you frustrated.
Breast augmentation insurance coverage
I do not know of any insurance companies that will pay for breast augmentation surgery. They may cover a breast deformity it a young adult who has Poland's syndrome or maybe a tuberous deformity. But most won't.
Augmentation for Asymmetric Breasts
Insurance companies will sometimes cover a unilateral augmentation when there is very significant asymmetry. They may consider it a birth defect, which in fact it is. There is no way to know without asking. Ask your plastic surgeon to write your insurance company to see if they will cover the procedure; then you will know for sure.
Insurance coverage for breast asymmetry
Typically insurances cover procedures that improve function or relieve pain or other medical issues. Reconstructive surgery is viewed as making something abnormal appear more normal. Cosmetic surgery is viewed as enhancing something that appears normal. Obviously insurance companies vary widely in how they interpret those definitions. If you have significant breast asymmetry, they will be unlikely to pay for augmentation. They may pay for a reduction of the larger breast if it is causing postural problems and back and neck pain due to the imbalance on your chest. First decide along with your plastic surgeon what procedure will benefit you the most. Then consider insurance coverage is appropriate. Don't let insurance coverage dictate the best procedure for you.
Congenital and asymmetric breasts
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It is highly unlikely that any insurance complan y will pay for placement of an implant for management of a congenital breast asymmetry in my experience.
In some instances, they may perhaps be willing to reimburse a portion of performing a reduction on the larger side (D down to a B) but you would need to request that your plastic surgeon draft a letter with photographs to support your claim. It is not unusual for plastic surgeons to charge for this process.
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.