Does Insurance Cover Tubular Breasts Since It is Considered a 'Congenital Anomaly' ?

You should ask your insurance provider if your surgery would be covered. However, in general, tubular breasts are not a health hazard. Corrective surgery is aimed more to improve their aesthetic appearance, rather than improve function or address a health problem.

In considering your Plastic Surgeon to help correct your Tuberous Breast, choose someone with a great deal of breast surgery experience of all types. This surgery is multifaceted requiring a Board Certified Plastic Surgeon well trained in all types of cosmetic and reconstructive breast surgery. Dr. Horowitz has an aesthetic vision and detailed eye combined with the finesse and skill to work with you to achieve the improvements you desire. It is critical to analyze the shape and contours of both breasts and understand beautiful, natural aesthetics of the breast and body. A passion for detail and the ability to form a warm and caring bond with his patients is essential to help treat this deeply emotional medical condition and improve your sense of well being and self-esteem which can completely transformative.

Intended Results

The ultimate goal is to achieve improved breast shape and symmetry as best as is possible given the starting anatomy. Realistic goals and expectations are important, as in all surgery. It is common that more than one operation is required and the breast shape will change even during the first few months after surgery.

Healing

This will depend on the procedures used and can be found in the sections on Breast Augmentation, Breast Lift, and Breast Reduction.

Insurance

Although this is technically a reconstructive operation by definition, many insurance companies will unfortunately and unreasonably have specific exclusions in their guidelines.

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance. Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

In most cases, insurance companies consider tubular breast surgery a cosmetic procedure.  However, it never hurts to contact your insurance company to check on your individual policy.  As plastic surgeons, we have no control over what the insurance company will cover.  After a consultation, we can write a letter and send photos and maybe a sympathetic insurance company would agree to cover it, but don't hold your breath - insurance companies generally try to find any excuse to not cover a procedure.  If money is an issue, most offices offer some type of financing programs such as Care Credit where you can pay for the procedure over time.

 

Good Luck.

The same thing applies to protruding ears, large noses, and even large breasts, though insurance coverage is sometimes obtainable for breasts large enough to exceed certain height/weight guidelines.

But, tuberous breasts are generally considered "cosmetic" in nature by most insurance companies. You should see one or more ABPS-certified plastic surgeons in New York who can tell you honestly what your chances are of obtaining coverage. Truthfully, I would expect them to be low. I practice in Minnesota, the home of HMOs and health-care insurers, and have been a reviewer for Blue Cross/Blue Shield and Medicare for years--this would not be a "covered" expense, even with appeals.

So, be prepared to pay, but that means you get to choose the expert plastic surgeon who you want to do your surgery. Interview carefully, and choose wisely, so your result is good and you are happy. . . otherwise, you may end up having additional reconstructive work (that may or may not be covered as well) to correct poor initial surgery! For examples see cases 1 and 3 via the link below. Best wishes!