I had a lumpectomy years ago and didn't consider breast aug then. Would it be covered now?

Question

I had a lumpectomy due to cancer on one breast 8 years ago. Now I have lost a lot of weight and the size difference between both breasts is quite obvious and is bothering me. I moved to CA from another state and have a different insurance now. Is there a chance that the insurance might cover a breast augmentation?

Ronald J. Edelson, MD · Answer

Insurance companies must ya for reconstructive breast surgery resulting for breast cancer.  You should consult a plastic surgeon who can send photos of your situation to the insurance company to determine if your case meets their criteria for coverage.  It will depend on the extent of the deformity as to whether they will consider this to be reconstructive in nature as opposed to purely cosmetic.  Good luck.

Brian C. Reuben, MD · Answer

Thank you for your question.  In short, yes, it is often possible to have insurance coverage for surgery to create symmetry for the breasts.  Best to check with your insurance carrier and see what their coverage is.  They should be able to tell you exactly what your policy contains.  Best of luck.

Kyle Song, MD · Answer

In 1998, the Women's Health and Cancer Rights Act was passed into federal law which requires insurance companies to cover treatment and reconstruction for breast cancer.  There is no statute of limitations, and you are eligible for reconstruction at any point in your life.  There are many techniques available to improve your symmetry including the use of a breast lift, breast implants, fat grafting, or rearrangement of your breast tissue to fill in the defect.  It all depends on the result you are looking for, and your anatomy.  If you had radiation at the time of treatment, this will also impact the decision-making process.  Hope this helps.

Kenneth Hughes, MD · Answer

This is certainly possible, but the insurance companies will all have different coverages.Kenneth Hughes, MDLos Angeles, CA

Antonio Gayoso, MD · Answer

Patients who have had mastectomy or lumpectomy due to breast cancer most likely will be covered for reconstructive surgery due to the 1998 Women's Health and Cancer Care  Act, which is a federal law. Please discuss this with your plastic surgeon. The American Cancer Society website has some good information regarding this mandate. There are a few limitations with this law (for instance, I don't think Medicare is covered under this law), however, it is worth investigating.

I had a lumpectomy years ago and didn't consider breast aug then. Would it be covered now?

Answers (9)