Breast Reduction Went Wrong: Will Insurance Cover a Revision?

Question

I tried to have a breast reduction 14 years ago but the doctor did one side and let a resident do the other. It was a disaster and after two more surgeries he had put big implants in with one side much bigger than the other. They were never reduced.

	They have gotten larger with age and I have had 10 back surgeries. Do you think the insurance will cover it. I am 5'7" 130 lbs and wear a 36-38 DD. My shoulders and upper back hurt all the time. I don't have the money to pay for it.

David Shafer, MD, FACS · Answer

There is no easy answer to your question.  Based on your story, you do seem to be a good candidate.  However, it really is dependent on your insurance company and your doctor.  So, I would suggest working closely with your doctor and your insurance company to make sure that every effort is made to help get your surgery covered by insurance.

	 

	Good Luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Unfortunately, there is no way of knowing what a specific insurance company will deem &ldquo;medically necessary&rdquo; and covered by their plan. It will be in your best interest to visit with a well experienced board-certified plastic surgeon who can approach the insurance company on your behalf. The more support you have from your other treating physicians the better.

	Best wishes.

Robert L. Kraft, MD, FACS · Answer

Usually, if a breast reduction was covered by insurance, additional surgery to deal with complications would also be covered.  However, your revisional surgery involved implants, which are, in most instances, not covered except for in breast reconstruction after mastectomy.  The rule of thumb is that if the insurer paid for those implants, they will probably also pay for correction---unless your policy provisions have changed or their clinical guidelines have been modified since the time of the last surgery.  From your posting, I haven't quite figured out how you went from a reduction for back pain to implants but the full history is something you can definitely discuss with a board certified plastic surgeon in consultation.  I would recommend that you obtain a complete copy of your medical records from the initial treating doctor or, if he is no longer available, from the hospital at which the procedures were performed so that any plastic surgeon you see now can get the full picture.  Good luck!

John P. Di Saia, MD · Answer

Hello,

	 

	While I feel for you and your situation, trying to predict what an insurance company will cover these days is difficult at best. Try to obtain pre-approval and hope for the best.

	 

	Best Regards,

	 

	John Di Saia MD

Grant Stevens, MD · Answer

With your back surgeries and history of failed surgery I would think that your insurance would cover your breast reduction, lift, reconstruction, implant explantation.    Who is your carrier?  PPO?  HMO?  Consult with a Board Certified Plastic Surgeon in your area.  I suggest a member of the American Society of Aesthetic Surgeons and one who does many breast reductions a month.  Revision surgery of this kind can be trickey.   Good Luck!

	Dr Grant Stevens

Breast Reduction Went Wrong: Will Insurance Cover a Revision?

Answers (5)