Would board certified plastic surgeon take Medicare for explant?

Question

Old breast implants, capsule contracture, pain and possible rupture. Have 45 year old silicone breast implants (1974) with severe capsular contracture & pain. Willing to travel to any state for explant. Mammograms and ultrasound show no problems. Primary doctor refuses to get MRI. Since implants so old, suspect damaged, maybe silent rupture. Have swollen neck lymph nodes. Blood work appears normal. Getting CT-Scan of neck tomorrow. I’m 69 years, live alone, and need financial help for explant. Is any board certified doctor willing to take Medicare for this?

Camille Cash, MD · Answer

Medicare will cover the removal of the implants if it can be shown that it is medically necessary.  Your test results should reveal whether the implants have ruptured.  If so, you may have coverage for removal.  At that time you can get a referral from your treating physician for a board certified plastic surgeon near you.  Please be aware that a breast lift, implant replacement, or any other procedure that is considered cosmetic will not be covered by insurance.

Donovan Rosas, MD · Answer

Medicare will only cover medically necessary procedures. An explant does not necessarily qualify unless a medical necessity can be proven. Capsular contracture and rupture are indications for removal. This will not, however, include cosmetic procedures such as replacement or mastopexy.Once a medical necessity has been documented, you can seek out referral to a board certified plastic surgeon who participates with Medicare.As always, discuss your concerns with a board certified plastic surgeon (ABPS).Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
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Surgery, American Society of Plastic Surgeons
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Kenneth Hughes, MD · Answer

In general, Medicare's benefits apply to medically necessary treatment for covered conditions. If your breast implants must be removed because the outer shell has broken, there is an infection or it prevents treatment for breast cancer, it may qualify for Medicare coverage through Part A. Await the results of your tests, and then phone several board certified plastic surgeons' offices to ask the patient coordinator whether Medicare reimbursement for implant removal is accepted. Care Credit and Alphaeon may allow you to finance the surgery if Medicare does not cover.

Daniel Barrett, MD · Answer

Dear mareallyself,
Every plastic surgeon has his own policy regarding payment. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only that way you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Chris Funderburk, MD · Answer

The current FDA recommendation for silicone breast implants is an MRI at three years post implantation and every two years thereafter. Unfortunately, insurance carriers frequently do not cover the scan. 
That said, severe capsular contracture is definitely an indication For either implant removal and capsulectomy or implant exchange and capsulectomy. This procedure is performed by fully trained plastic surgeons including board-certified surgeons. Please check with the individual office or Hospital department of plastic surgery to check your coverage prior to your consultation. The office staff should be able to direct you accordingly.

Would board certified plastic surgeon take Medicare for explant?

Answers (8)

Answer: Implant removal

Answer: Implant removal

Answer: Breast implants and capsular contracture

Answer: Breast implants and capsular contracture

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Would board certified plastic surgeon take Medicare for explant?

Answers (8)

Answer: Implant removal

Answer: Implant removal

Answer: Breast implants and capsular contracture

Answer: Breast implants and capsular contracture

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Recommended reading

Everything you need to know about Breast Implant Removal

Our mission is to create a world where every investment in modern beauty is Worth It.