Is It Possible to Have Insurance Cover Implant Explantation?

Question

I had McGhan saline implants placed subglandularly in 2000. I've developed capsular contracture in my rt breast. Since 2006 I've suffered from terrible hair loss, itching skin, fatigue, joint pain. I've seen 3 doctors with all tests negative. Could the implants be the cause? I'm a RN, and I'm wondering if ins ever pays for explantation, or if there are any programs/studies to offset some of the cost. (The implanting dr is retired, so returning to him isn't possible.)

Jed H. Horowitz, MD, FACS · Answer

Good day! Any
insurance might not cover explantation because it is considered
as a cosmetic procedure, not a medical necessity. More so with your
history of breast augmentation. They may, however, consider covering the
procedure if there is a legitimate medical reason. It is best to
have an in-person examination so that costs will be customized according to
your needs. You may also ask the manufacturer of your implant if explantation
is covered in their warranty or insurance that you paid when you got them. Best
of luck! #RealSelf100

Jeffrey E. Schreiber, MD, FACS · Answer

Insurance coverage is different for every person, so you'll have to visit with a plastic surgeon for full assessment and insurance verification for this procedure.

Otto Joseph Placik, MD · Answer

As stated by Dr. Pelletiere, each policy has its own provisions and do not consider explantation a covered benefit. However, you could contact your insurance carrier or have a plastic surgeon compose a predetermination of benefits letter to your carrier.

Christopher V. Pelletiere, MD · Answer

In general, most insurance companies will not cover anything to do with breast implants if they were placed for aestehtic reasons only, even if you are having pain from them now. It does not hurt to undergo the pre-certifiation process, but I would not hold your breath for a positive response. The chances of your implants causing your symptoms are extremely small. The ten year core and adjunct studies done by both implant manufacturers ( Mentor and Allergan) were unable to find any symptoms or disease processes that were more prevalent in women with or without implants. The same goes for all the European studies, as well as the 1997 Institutes of Medicine study. That is not to say that something cannot go on, but it would be very rare. I hope this helps.

Tom J. Pousti, MD · Answer

Unfortunately, it is very unlikely that health insurance companies will cover breast implant removal that were placed for aesthetic purposes. However, there is no way to know for sure without attempting.

	Best wishes.

Steven Wallach, MD · Answer

Insurance companies all have their own specific criteria for approving surgery. You should contact your insurance carrier and ask them what their policies are.

Is It Possible to Have Insurance Cover Implant Explantation?

Answers (6)