Will Insurance Pay For a Reduction if You Have Implants? I Was a Saggy C Before, Now 40E?

Hello Reduce me Mpls,

Symptomatic macromastia (painful large breasts) is a medical condition, regardless of whether the cause is natural breast tissue or implants.  So theoretically it is coverable by insurance.  You and your chosen surgeon may opt to have removal of implants covered by insurance and still do non-medical procedures performed simultaneously (breast implant replacement and breast lift).  This is not insurance fraud and perfectly legal, as long as you are paying a reasonable fee for the cosmetic portion of the surgery.

What you are considering is not simple, and requires experience and talent on the part of your surgeon.  I recommend you visit only surgeons with excellent reputations for breast surgery that are certified by the American Board of Plastic Surgery, and are also members of the American Society for Aesthetic Plastic Surgery.

Best of luck!

In my experience I have never had an insurance company cover costs for breast reduction caused by too large implants. I doubt that this will be approved.

Anything is possible but in your case it would be doubtful. Seek in person evaluations and possible pre determination letters to your health insurance company. In my experience the insurance will most likely deny your request. But worth a try. 

Hi Reduce Me Mpls,

Insurance company coverage varies for each procedure by policy.  You should check with your insurance company.  In my experience, in New York State, this is not covered.  Now, as to what your options are.  You said before surgery you were a C cup and sagging; you then had a lift with implants.  Currently, your breast size is very large.  The question is, when you were a C cup, were you happy with the size in a bra?  If so, then a lift alone would have sufficed.  However, now that you have had the implants for 12 years, your existing breast tissue may have shrunk, so when the implants are removed you may be smaller than you were before the implants.  Your plastic surgeon can determine after examining you how much breast tissue you currently have.  If you have enough of your own breast tissue and you were happy with your size in a bra before your surgery,  my advice to a patient with this situation in my practice would be to remove the implants and do a breast lift, focusing on really lifting and shaping the existing breast tissue.  If there is too little breast tissue to create a pleasing shape and size (probably C cup is desired), then a small implant is perfectly appropriate.  The key to a successful outcome is a very clear understanding between you and your plastic surgeon as to what size you want to be.  In my office we use pictures to communicate preferences about breast size and this is very helpful for both myself and the patient.  Hope this helps.

Tracy M. Pfeifer, MD, MS

I doubt that an insurance company will "cover" a reduction when a patient has implants.  You certainly can ask the insurance company what their policy is.

Thank you for the question.

Obtaining coverage for breast reduction from insurance companies becomes more challenging every year. The fact that you have breast implants in place will further increase the challenges of obtaining coverage.

The first place to start would with be a visit with a well expensed board-certified plastic surgeon who after direct exam  will be able to advise you.

Best wishes.

Most insurance companies would not cover reduction done by removing implants. You would almost certainly need some kind of a lift after taking the implants out but do NOT do it at the same time. The breasts can change significantly over 3 months and you really don't know how much to lift them until after that change takes place.