For Canadian doctors: on breast augmentation. Can this be covered by OHIP as reconstructive surgery?

Question

Late diagnosed with Congenital Adrenal Hyperplasia (CAH), hormone replacement therapy has failed to achieve breast growth (I'm about a 2 in Tanner stages), and implants are my only option now. I'm wondering, can they be covered by OHIP as "reconstructive surgery", given my diagnosis? My CAH has lead to severe gender dysphoria, and I'm aware top surgery for transwomen and cancer survivors is covered for similar reasoning. Thanks

Mats Hagstrom, MD (license on probation) · Answer

I’m not a Canadian plastic surgeon. It is unlikely any insurance company is going to cover breast implants and a genetic female due to having small breasts.
You should be able to contact the insurance nerwork and ask them what their insurance coverage criteria are.
Almost all medical insurance companies, whether run privately or by the government are based on some contractual guidelines.
Procedure authorization is usually associated with a justifying diagnosis code.
I suggest contacting some local plastic surgeons in your community though I think it is highly unlikely your desired surgery will be authorized.
Doing so opens the floodgates of every woman wanting breast enhancement.
Best,
Mats Hagstrom, MD

For Canadian doctors: on breast augmentation. Can this be covered by OHIP as reconstructive surgery?

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For Canadian doctors: on breast augmentation. Can this be covered by OHIP as reconstructive surgery?

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