Will Medicare Cover a Breast Lift/Reduction After a Lumpectomy & Radiation 20 Years Ago?

Doctor Answers 4

Breast Surgery and Medicare Coverage?

Thank you for the question.

It would be in your best interest to be seen by a well experienced board-certified  plastic surgeon to determine whether you  are a candidate for the procedure or if the skin changes caused by radiation expose you to significant risks associated with the procedure (such as wound healing problems etc.).

Once the plastic surgeon determines you are a good candidate  and can document that the procedure is medically necessary then there is a good chance that  insurance companies/ Medicare  may cover the procedure. Unfortunately, Medicare does not pre-authorize so obtaining as much documentation  as possible (is in regard to medical necessity)  from your other physicians  will be helpful.

I hope this helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Medicare coverage for breast surgery

Unfortunatelly, Medicare will not prior authorize any surgery so there is no way of knowing in advance whether there will be coverage. They base their decision on whether the surgery is medically necessary. In general a breast lift is not covered as it is considered cosmetic. However, if it is to make the breasts match better after breast cancer surgery, it should be covered. Breast reduction may be covered if it is medically necessary, for example to treat back pain. But you should be aware that surgery on any tissue that has been irradiated is more likely to have post-operative complications. You should seek a consultation with a board certified plastic surgeon to discuss your concerns and reasons for surgery and to find out what your options are surgically. These should be at least as important as concerns about insurance coverage. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon
3.6 out of 5 stars 13 reviews

Will Medicare Cover a Breast Lift/Reduction After a Lumpectomy & Radiation 20 Years Ago?

Please see a boarded PSs in your area to examine you and discuss your options. In many cases breast reconstruction is a covered benefit by medicare. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Will Medicare cover my surgery

I recommend that you seek a consultation from a board-certified plastic surgeon.  In order to determine eligibility for a breast reduction, various factors will need to be taken into account such as your height, weight, body mass index, and the amount of tissue that the surgeon estimates can be safely removed.  Or, it may be that the procedure will be covered related to your lumpectomy/breast cancer surgery to create better symmetry.   Good luck!



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