Does insurance cover breast augmentation if I was born without breast tissue?

I am a 21 year old woman and I was born a woman (with women genitalia) but I never got a period, so essentially could never go through puberty on my own. With doctor's help, I have been on medication to produce a period and puberty. I still have never developed any breast tissue (none at all) and doctors say I never will. My question is that, since this is considered a congenital anomaly, will my insurance cover some of the expenses for a breast augmentation?

Doctor Answers 5

Insurance coverage of breast implants

Insurance coverage of breast implants

There is a difference between cosmetic and reconstructive surgery.  If you were born with true hypomastia or lack of beast tissue this might be considered as a reconstructive procedure and thus covered by your insurance.  You should consult with an ABPS certified plastic surgeon to examine and document your specific situation and plan.  He or she can then submit to the insurance company for approval.

Consultation with one or more ABPS-certified plastic surgeons who can identify and document the details of your congenital lack of breast development may indeed allow insurance coverage for breast augmentation with implants. I was a reviewer for Blue Cross/Blue Shield and Medicare for many years and this would be considered (with proper documentation) a covered expense by many plans.

I hope this helps,

Alex Campbell, MD

Insurance Coverage for Breast Augmentation

It certainly is worthwhile to inquire with your insurance company.  You may be able to obtain this information yourself or you can see a plastic surgeon and a letter and supporting documentation can be submitted to your insurance company to obtain a pre-determination.  I would suspect that coverage would be available although you will need to see a surgeon who is in your network if you wish to obtain the maximum coverage possible.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 73 reviews

Congenital lack of breast growth may be reason for insurance coverage of breast augmentation.

Consultation with one or more ABPS-certified plastic surgeons who can identify and document the details of your congenital lack of breast development may indeed allow insurance coverage for breast augmentation with implants. I was a reviewer for Blue Cross/Blue Shield and Medicare for many years and this would be considered (with proper documentation) a covered expense by many plans.

Prior-authorization by your chosen plastic surgeon can determine exact coverage requirements and the specifics of your own plan's benefits. For more information about the breast augmentation operation, you can click on the web reference link below for my Comprehensive Guide to Breast Augmentation. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 240 reviews

Born without breast tissue.

I feel the answer to your question is indeed a yes, your insurance should cover implants and everything given proper evaluation of your congenital anomaly. The request for predetermination from the insurance will take effort and possibly an appeal or peer to peer review, but we feel it should work out in the end. Good luck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 40 reviews

Does insurance cover breast augmentation if I was born without breast tissue?

Thank you for your question.

As a general rule, insurance companies do not cover breast augmentation, except in cases when one breast has had surgery for breast cancer, and augmentation has to be done to the non-cancer side to achieve symmetry.

Having said that, in the case of a congenital anomaly such as yours, many insurance companies will cover breast reconstruction.  While the mechanics of the procedure are similar, the rationale is not.  Because you'd be correcting a congenital anomaly, rather than altering an otherwise normal appearance, the procedure is not considered an augmentation, but instead a reconstruction.

A consultation with a board-certified plastic surgeon will help you tremendously - they'll be able to go over your surgical options, and their staff should be able to help you navigate the challenges of getting insurance approval.

Best wishes.

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.