Is it possible to have tuberous breast reconstruction covered by health insurance?

In my experience tuberous breast reconstruction is not covered and are considered a cosmetic procedure. Health insurance only covers medically necessary procedures.... (ie. Breast reduction due to back pain). Best of luck.

Dear mrd,    Insurance companies will cover surgical procedures if they are medically necessary in order to improve on your health or your ability to function. Tubular breasts surgery is considered cosmetic surgery and not medically necessary. On rare occasions, I had patients who were married to high level executives of big corporation that as part of their bebefits, cosmetic surgery was covered too by their health insurance. Tubular breasts surgery require more expertice than regular breasts augmentation , so do your due diligence as far as surgeon selection. Always, consult with board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures to make sure that they are numerous, consistent and attractive. Check also the 'realself' reviews for positive patients experience which provides important information on the surgeons.                  Best of luck,                                  Dr Widder

Thank you for your question!  Without an examination or photos, I can not say if you have a true tuberous breast deformity.  The standard
procedure would be placement of an implant (or tissue expander,
depending on the lower pole of your breast) as well as a circumareolar
breast lift. These modalities would correct the issues with tuberous
breast: constricted breast at the inferior pole, via breast prosthetic;
scoring of the tissue to release the bands; lowering the inframammary
fold; correcting the herniation of breast tissue into the areolae; and
decreasing the overall size of the areolae. These are the hallmarks of
tuberous breasts. You could likely get great results with an implant
and possible breast lift. Often times, since there is no functional issue with this defomity, most insurance providers consider this an aesthetic issue, and oftn have exclusion criteria for this procedure.  Consult
with a plastic surgeon well-versed in breast surgery and discuss your
goals and expectations. S/he will then be able to examine and discuss
the various options and assist you in deciding which decision is the
right one for you, given your desires. You can discuss the possibility for insurance coverage then.  I would expect a very pleasing
result for you! Hope that this helps! Best wishes for a wonderful
result!

I have never had this covered on my patients in 23 years of practice as the insurance companies consider it not medically necessary as it does not effect your normal bodily function. Breast reduction can eliminate pain and other issues that cause long term bodily problems. Tuberous breast are a cosmetic issue for the most part. Coding will have nothing to do with insurance coverage.

Insurance coverage is not likely, though there is nothing wrong with a surgeon in your plan to see you and request an insurance predetermination for coverage. Significant lack of breast development and asymmetry may be in your favor.

In my experience, it is very unusual for insurance companies to cover correction of a tuberous breast. The only time when I have been successful, is when the patient also has significant asymmetry associated with the tuberous breasts. And even in that situation, it is primarily the asymmetry of volume that is being covered by the insurance company and not the surgery to correct the tuberous breast condition.

Since the procedure does not affect function, the insurers consider the correction of tuberous breasts to be a cosmetic procedure. Coding should not make a difference. All the best

Thank you for your question.  In my experience reconstruction of the tuberous breast is almost always considered a cosmetic procedure.  You of course can ask your primary physician to submit a request for insurance coverage to see if you can obtain prior approval. For more information on tuberous breast please read the following link: