Breast Reconstruction Due to Eating Disorder Covered by Insurance?

I suffered throughout my teens and twenties with an eating disorder - and bound my breasts throughout those same years. Although my breasts are not very large (b cup) it is quite obvious that the muscle tissue has been compromised. I have had a family Doctor suggest I look to insurance to cover a breast lift/reconstruction. Is Breast reconstruction an insurable option?

Doctor Answers 6

Insurance coverage for breast lift

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Unfortunately breast lift surgery is not covered by insurance.  You will have to figure out a way to pay for it.

Insurance Coverage for Breast Reconstruction

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Reconstruction after mastectomy or for breast cancer must be covered by insurance thanks to the only health care mandate that is federal law (1998 federal law).   However, for your scenario, insurance companies will deem any surgery for your breasts as cosmetic.  Please visit with a board certified plastic surgeon to learn more about your options

Breast Reconstruction for atrophy due to eating disorder

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Hi there-

I am very sorry to hear that you are still having to deal with physical problems relating to your previous problems with food... I hope you are able to achieve long term happiness and peace.

Unfortunately, I do not think that you should be optimistic that your insurer will care whether or not your breasts are pretty, or even within the range of what a reasonable person would call normal in appearance.

The unfortunate truth is that the insurance programs are "for-profit" entities... Unless you have had a mastectomy, their bottom line is much more important to them than how happy you are with your breasts.

On the other hand, there are many options for achieving the breasts you dream of, and a visit with a skilled surgeon certified by The American Board of Plastic Surgery would be in order. Payment and financing options are available that may make it possible for you to indeed be very happy with yourself going forward.

Insurance for perceived breast deformity

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I am sure you went through a very difficult time in your teenage years with an eating disorder. Unfortunately, insurance will only pay for medical problems such as breast reduction causing back pain or a deformity caused by a disease such as breast cancer or trauma. Although you may be unhappy with the appearance of your breasts that would not be a reason for insurance to cover the surgery. In my 20 years of practice, I have never known them to do this and it is just the opposite - they don't even like to pay for true deformities. Sorry.

Breast reconstruction for non-mastectomy situation

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I am sympathetic to your situation but doubt you will be able to fine any coverage for anything considered to be "breast reconstruction" other than for a mastectomy. Whatever else has caused the breast issues would be considered cosmetic since you can "live" as you are.

Remember that insurance draws a sharp line between anything that is "functional" and is medically necessary for your survival and groups all else into the non-covered cosmetic these days. This will only get worse with the new government health plan.

Insurance Coverage for Psychiatric related Breast Deformity

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Improving the appearance of the breast is RARELY if ever an operation paid for by insurance companies. In my experience, they never pay for straight forward breast lifts and I seriously doubt that they could be induced to pay for a potentially more complicated breast lift / reconstruction possibly related to your former, now hopefully corrected, eating disorder and breast binding.

I would contact several Plastic surgeons (check near you and see several of them. You will learn your options and what the prevailing insurance companies may pay for.

Peter A. Aldea, MD
Memphis Plastic Surgeon

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.