2 yrs after nipple sparing mastectomy left breast drop. Is it medically necessary to fix it?If not insurance won't cover.(photo)

I'm very concerned it's not covered and I won't be able to afford to get it fixed on my own.. I'm 27 thought this was behind me, please let me know if it seems medically necessary.. I was already unhappy with the turn out but was happy to be alive but I'm completely devastated

Doctor Answers 4

Breast drop

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I am sorry about your dropped breast reconstruction. Insurance generally always pays for revision of breast reconstruction so I encourage you to check it out. I personally think any reconstruction issue that bothers a patient after mastectomy is a "medical necessity" for her mental and emotional health. You absolutely should proceed with consultation and revision to improve the cosmesis of your breast. Your surgeon should be able to request and get authorization. Good luck and take care.

2 yrs after nipple sparing mastectomy left breast drop. Is it medically necessary to fix it?If not insurance won't cover.

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Thank you for your question and photographs, and I am sorry to hear about your left breast drop. I can imagine how emotional of a time this must be for you.  Typically, in cases of breast cancer reconstructions, if your insurance carrier paid for the original mastectomy and implant reconstruction, future revisions are also covered by your plan.  Because an in-person examination is really needed in order to determine how and where your implant is sitting, i would reach out to your plastic surgeon and voice your concerns. They will best be able to diagnose what has taken place and offer you treatment options to get you to a result that you are more pleased with.  Hang in there!

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Post-mastectomy revisions must be covered!

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Without knowing your medical and surgical history, I can't be sure why your reconstructed breast has changed (implant deflation or rupture is possible).  You should seek the expertise of your plastic surgeon, or if not feasible, a board-certified plastic surgeon with expertise in revisional post-mastectomy breast surgery.  The good news is: according to Federal Law, any and all procedures related to post-mastectomy reconstruction must be covered by health insurance companies, including asymmetry procedures to the other breast.  Good luck!

Jay Meisner, MD
New York Plastic Surgeon

Breast reconstruction

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Generally speaking insurance is required to cover surgery related to reconstruction of your breast and any procedures on the opposite related to improving symmetry.  Therefore, I would think insurance would cover.

That said, if for some reason the appearance didn't bother you; you would not have to medically have more surgery to correct it.  I understand it does, and you should see a Board Certified Plastic Surgeon in your area to see what would be involved in improving this.  Good Luck!

Christopher A. Marek, MD
Lexington Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.