Will Insurance Pay for Breast Reduction After Lumpectomy?

Hello! Thank you for your question! Contour deformities or asymmetry between size/shape of the other breast following lumpectomy and radiation may occur after everything settles and is not an uncommon scenario following lumpectomy. There are several options to ameliorate this and you should discuss your options with your plastic surgeon to determine which option would be best for you. It is recommended to wait approximately 6 months to one year after your radiation therapy is completed before considering any reconstructive procedure on the breast.Typically, implants in the setting of an irradiated breast has higher rates of complication, including infection, wound complications, capsular contracture, etc. Many surgeons, including myself, have placed implants to improve symmetry in these instances with excellent results. However, if your deformity is a contour issue with a soft tissue deficiency, placing an implant beneath the breast may actually worsen the deformity as it is not addressing the issue to "fill" the defect. For such problems, it may be a wiser decision to consider fat grafting for smaller defects, where fat is harvested for another area of your body and then reinjected into the defect, thus adding volume as well as having the added properties of fat graft stem cells. Autologous flaps such as local tissue, TAP, or LDMF may be needed for larger soft tissue defects. Of course, reduction of the other breast to create symmetry is an option, or a combination of procedures on both breasts.  Reduction is a great method to achieve symmetry and improve appearance. Insurance typically should cover this with your history of breast cancer. Best wishes!

Thank you for your question.

Insurance companies are more difficult to work with and each one has it's own criteria for what they will or will not cover.  The first step would be to visit with a surgeon who could help you achieve your goals and see if he/she accepts insurance for this type of surgery.  The doctor would then send paperwork trying to get authorization for the surgery.

In my practice, I send a letter as well as patient photos and any supporting documentation as to why this surgery should be covered by insurance.

Best Wishes.

Health insurance companies (including BCBS) are required, by federal law, to cover any procedure done to "restore symmetry" after a patient has surgery for treatment of breast cancer.  So you should have no trouble getting coverage.  All that is left to do is to see a board-certified plastic surgeon for a consultation and have him/her submit the appropriate documentation to you insurance company.