I had a partial mastectomy in August. Will insurance cover breast reconstructive surgery even if the diagnosis wasn't cancer?

After having a partial mastectomy my breast was left with a couple deformities. I have a dent from where the breast tissue was removed and my breast are uneven due to this. I was told after talking to a plastic surgeon that my insurance may not approve this because the diagnosis wasn't cancer. Is there anything that can be done? I'm only 25 and would absolutely hate having to live with these abnormalities for the rest of my life.

Doctor Answers 3

Partial mastectomy and no cancer diagnosis

Thank you for your question. First of all, it is great news that your diagnosis was not cancer.   When it comes to reconstructive surgery it usually depends on your insurance carrier.  Your PS can submit for insurance approval and see what the outcome is.  You can also contact your insurance carrier and let them know that you had a "partial mastectomy".   The word mastectomy is important in non cancerous defects.   Lumpectomy is not a good word in these cases.   Best of luck. 

Insurance coverage

The only way to know is to ask.  See a surgeon who is experienced in breast reconstruction and discuss what may need to be done.  Your doctor can then submit a predetermination letter to your insurance company (usually with photos) that outlines your situation and the proposed procedures to correct it.  That way you will have confirmation in writing of coverage before you proceed.  Good luck!

Scott Thellman, MD
Lawrence Plastic Surgeon
5.0 out of 5 stars 3 reviews

Contact your insurance company

I would contact your insurance to see if the procedure is covered. Most often times insurances will cover all reconstruction post mastectomy due to diagnosis  of cancer. If you were not diagnosed with cancer, but there is enough concern of this to have a partial mastectomy it may be covered. If you are BRCA positive or have a family history of this diagnosis it may be covered. Again I would contact your insurance to confirm. 

Alexander J. Gougoutas, MD
Seattle Plastic Surgeon
4.7 out of 5 stars 7 reviews

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