Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Question

I have read many answers that say a breast lift will not be covered unless it is part of a medically necessary breast reduction, which I do not want. My 40D breasts are large and sagging (I am only 23) and I sweat profusely. The heat and sweat causes me to get a fungal rash in the under part of my breast that oozes, causes pain, and even causes tears in the skin. My bras are washed regularly but the problem persists. Could insurance cover it if my surgeon thinks it will help?

Jose Perez-Gurri, MD, FACS · Answer

Hi.the procedure you are referring to is a breast reduction rather than a lift. In a lift only skin is removed, whereby in a reduction skin and breast tissue is removed. As far as your age, height, weight , and bra size, it certainly sounds like you could benefit greatly. I recently performed a breast reduction on an 18 year old. It's probably the most rewarding breast surgery that I perform. The patients are so grateful. You are young and the situation will only get worse for you. The other questions you need to ask, ( which I am sure your mom has) is "Will my beasts continue to grow? What happens when I have kids? How big will my breasts get? Will I be able to breast feed? ". These are all questions I like to address with the patient and her mom or parents. It's usually the mom who accompanies young women considering this surgery.Insurance companies require lots and lots of documentation in order for them to even consider paying for a breast reduction. Some insurance companies actually exclude breast reduction as a covered procedure. If it's a covered procedure then pre-op photos need to be submitted. The patient must have had a prior history of a year's worth of conservative therapy by their private doctor, frequentky insurance companies will require that you have also established a medical record with either an orthopedic surgeon or chiropractor documenting your sympoms and most important is that a minimum of 500 grams must be removed at the time of surgery. This simply means that unless you have enough tissue they will not even consider it. A letter from an insurance company that it's a covered procedure does not necessarily mean that they will pay for it. Depending on an insurance company to pay for your breast reduction is like spinning the roulette wheel.Always seek out the opinion of a surgeon certified by the American Board of Plastic Surgery with years of experience in cosmetic breast surgery. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits?How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications.In our office, as in others, we use TouchMD which is a web based program in which patients have the ability to load their picture unto the program. The surgen can actually draw on the picture to show a potential patient where the incisions would be located and how the procedure is to be realized. It's all done to comply with HIPPA which is the federal law that protects the patient's medical information. Look them up.Good luck, Dr PG

Sheila S. Nazarian, MD · Answer

Sadly, despite your issues, your insurance company won't cover a breast lift. It's considered a cosmetic procedure. And given the fact that you're not interested in reducing your breast volume, a breast reduction wouldn't be right for you (nor would it be covered unless your were to take out a significant amount of tissue). Sorry that I couldn't be of more help.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry.  In general, breast lift without a major reduction component will not get covered by insurance.   Go seek the consulatation of a board certfied plastic surgeon for more clarification.  Also, a  breast lift procedures may be more affordable then you think.  Good Luck.

Richard Zienowicz, MD · Answer

Insurance will most likely not cover your breast lift. You will need to consider self pay and there are financing options available if needed. You can discuss with your doctor's office.

Jeffrey Zwiren, MD · Answer

Do not expect insurance coverage for a breast lift regardless of your symptoms.  Will only be considered cosmetic surgery.

Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Answers (8)

Answer: Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Answer: Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Answer: Breast lift is cosmetic surgery

Answer: Breast lift is cosmetic surgery

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Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Answers (8)

Answer: Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Answer: Will insurance cover a breast lift if there actually is a medical/non-cosmetic reason?

Answer: Breast lift is cosmetic surgery

Answer: Breast lift is cosmetic surgery

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Recommended reading

Everything you need to know about Breast Lift

Our mission is to create a world where every investment in modern beauty is Worth It.