Will insurance pay to have ruptured breast implants removed?

HI,Thanks for the question. The answer is tricky though. Insurance will not pay to have saline implants removed. They may pay to have silicone implants removed but it depends on the company and the policy type. The surgery you need also depends on how long the implants have been ruptured for. If they are silicone and have been ruptured for a while, then the pockets have contracted and the capsule has probably thickened. The capsule will need to be removed at least in part and the pocket re-expanded (if you want new implants). It is best if you contact your insurance company. Before you go to a plastic surgeon to discuss surgery, make sure that you have all of the information with you (type of implant, documentation of rupture etc.). I would certainly be happy to see you in my office to give you a more informed opinion. I hope this helps.All my best,Daniel A. Medalie, MD

Most health insurance companies review the original reason for you getting breast implants.  If your implants were inserted after a mastectomy 30 years ago and your current PCP or surgeon can prove that removal is "medically necessary" because of leakages, rashes, etc.,  removal of the silicone implants is likely to be covered. If the reason for having breast augmentation was for cosmetic reasons, insurance is unlikely to cover removal. Contact your medical insurance company for advice or read your medical insurance certificate of coverage.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Some insurance companies will pay, while others will not. Your surgeon's office should be able to tell you whether they accept insurance. If they do accept your carrier, they will be able to check in with the insurance company prior to surgery to "authorize" the procedure. Make sure you find an experienced surgeon.

Some insurances will, others will not.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Thank you for sharing your excellent question.  Some insurance plans may cover the cost but you would need to reach out to your insurance company to ask them directly.  It is best to have the shell removed in order to avoid future complications.  Hope this helps.

Hello Nita9627,
I appreciate your questions! The FDA recommends replacement of the breast implants after 10 years due to a higher risk of rupture. A ruptured breast implant indeed needs to be removed.  When a breast implant ruptures, one may develop a silicone granuloma. For ruptured breast implants, I would recommend waiting at least 6 months before placing a new breast implant since silicone granulomas may occur during that time. If a silicone granuloma develops, I recommend excision or removal of the silicone granuloma. I would recommend obtaining a mammogram prior to removal of the breast implants, and 3-6 months after removal. Hope this is helpful! Dr. De La Cruz.

The answer to your question is "maybe".  If the implants are silicone, insurance will sometimes cover removal of ruptured implants.  It will not cover the cost of a lift or replacement implants.  If the implants are saline, insurance typically will not cover the removal.  The exception is if the implants were placed due to mastectomy.  Implants placed for medically necessary reasons are often covered by insurance for removal.

If your 30 year old implants are ruptured, they should be removed along with the scar capsules that surround the implants.  Check with your insurance company to see if this surgery is covered by your insurance plan.  Some insurance companies do pay for this surgery and others do not.  Consult with a board certified plastic surgeon about your implants and surgical options.   Best wishes. 

It really depends on your individual insurance policy and what it covers.  Many companies do cover the removal of ruptured silicone implants (but not the capsule removal).   Most companies list their coverage criteria online, and then of course your individual policy would have to be checked.  Some companies consider rupture a complication of a cosmetic procedure and do not cover it.  I would see an ASPS board certified plastic surgeon and they can provide you with cost and help determine if there would be any insurance coverage.

Dear Nita,Any implant that is ruptured should be replaced.  Many insurance companies will pay for the replacement while others will not.  You must get pre-approval and may even have to pay for the procedure and wait for reimbursement from your carrier.  Best of luck.Dr Taranow