Does Medicare cover breast reconstruction for a partial mastectomy?

Question

I was given no information so I consulted with my surgeon who recommended breast conserving surgery over a mastectomy. My right cancerous breast was larger but the tumor was larger than anticipated and more tissue had to be removed to get clear margins. The result is terrible.

Allen Gabriel, MD, FACS · Answer

Thank you for your question.  Please visit a board certified plastic surgeons office who is credentialed with Medicare for evaluation.  If you are seeking any reconstruction on the lumpectomy side, please see the plastic surgeon as soon as possible before you start radiation. There are some options that can be discussed and Medicare does cover it. Best of luck.

Manish C. Champaneria, MD · Answer

Thank you for your question.The Women’s Health and Cancer Rights Act (WHCRA) helps protect many women with breast cancer who choose to have their breasts rebuilt (reconstructed) after a mastectomy. Mastectomy is surgery to remove all or part of the breast. This federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. It was signed into law on October 21, 1998.So, to answer your specific question, Medicare covers all types of breast reconstruction. In your case, it seems that an oncoplastic breast lift/reduction might be an option to reconstruct you breasts. This where the principles of breast reduction/lift are used to reconstruct the defect left after your lumpectomy.I recommend searching for a board certified plastic surgeon who specializes in breast reconstruction to help you.Good luck on you journey.Regards,Manish C. Champaneria, MD

Does Medicare cover breast reconstruction for a partial mastectomy?

Answers (2)