Can my Insurance Pay for Removal of Breast Tissue on Armpit While I Have a Breast Augmentation at the Same Time?

Question

I have had breast tissue on my left armpit for the past 14 years. Since puberty. It can be very painful (was very painful during pregnancy). I am very thin and it is very visible. I really want that removed and I'm wondering if my insurance can pay for something like that. If so, I am also considering breast augmentation since my B cups lost volume after pregnancy. Could my plastic surgeon do both at the same time if the insurance did pay for it? Since he is a plastic surgeon.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! Surgical procedures for aesthetic 
purposes, to improve appearance, are not covered by insurance. 
Typically, these as well as complications resulting from such procedures
 are the responsibility of the patient. Procedures that are meant to 
correct functional issues and those which cause health-related issues 
should be covered by your insurance as a medical necessity, with proper 
examination and documentation.  Some insurance plans have exclusion 
criteria for certain procedures.  Also, it is an obligation of the 
surgeon not to attempt to authorize purely cosmetic procedures through 
insurance.   It may be possible to perform these procedures together.  You should see a breast surgeon for this.  The facility and anesthesia times will begin once the excision portion ends.  Discuss your issues and 
complaints with a board-certified plastic surgeon to discuss these as 
well as to examine and assist you in deciding which procedure(s) will be
 the best for you. A discussion of the advantages and disadvantages will
 take place along with the risks and benefits. Insurance companies will 
vary on coverage and is always reasonable to discuss your issues with 
your surgeon and primary care. It would behoove you to get as much 
information as possible and even call your insurance yourself. 
Certainly, pay in advance prior to your surgical procedure and options 
such as financing are available if you qualify. Hope that this helps! 
 Best wishes!

Larry S. Nichter, MD, MS, FACS · Answer

Combined Cosmetic and Reconstructive Surgery is commonly done in my practice.. It is key to have prior authorization from your insurance company for the "insured" part of it as it is very hard to get authorization or payments after the fact. Typically the OR, Surgical Facility, and Anesthesia bills for the insurance part and you will pay for the time taken for the cosmetic portion (breast augmentation).

Susan Buenaventura, MD, FACS · Answer

Cosmetic and insurance based procedures can be combined, depending on your surgeon's practice.  If I have such a situation we do the surgery at the hospital to allow insurance to cover the surgery, anesthesia and pathology for the excess tissue removal.  Coolsculpting often works very well for that area too though it would not be covered by insurance, but avoids scar and downtime.  Meet with an ASPS plastic surgeon to discuss your options.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Generally speaking, it may be difficult for you to obtain insurance coverage for removal of axillary breast tissue. The only way to know for sure is to seek &ldquo;authorization&rdquo; prior to the procedure; your plastic surgeon will be able to help you with this.

	Yes, this is a procedure commonly performed by plastic surgeons and can be done at the same time as breast augmentation surgery.

	I hope this helps.

Steven Wallach, MD · Answer

It is quite possible that your surgeon remove the axillary breast tissue at the same time as the breast augmentation.

Robert L. Kraft, MD, FACS · Answer

Many surgical facilities will not accept the hybrid cosmetic/reconstructive case because of the differences in billing fees and concerns about legality.  You will not achieve a cost saving by combining the procedures and I would not recommend the transaxillary approach simply as a mechanism to attempt to achieve insurance coverage because it has its own intrinsic risks and complications.

Peter E. Johnson, MD · Answer

We have reduced axillary breast tissue at the time of transaxillary breast augmentation. Insurance coverage will depend on a predetermination from your particular insurance plan as to what is of 'medical necessity'. This can be tricky where cosmetic procedures are also involved.

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

Occasionally I will do liposuction to this area to improve the contour.  The tissue can be quite fibrous and it is a hard area for postoperative compression so patients have firmness in this area for several months.  On two occasions, I have even excised the extra "wad" of breast and left a scar in the anterior axillary crease.   I do this at the same time as the other breast procedure be it augmentation, lift or reduction. 

	Whether or not your insurance will pay for this is up to your insurance company.  I honestly would have a tough time making the argument for medical necessity but if you have an extreme case........maybe.

Alan M. Engler, MD, FACS (retired) · Answer

In general, insurance will pay for procedures that are deemed (by them) to be medically necessary.  This often includes a breast reduction if about 500 grams of tissue are removed from each side (more if you're a larger-than-average person, less if you're smaller).  The insurance MIGHT pay for the removal of the axillary breast tissue if you and your surgeon can demonstrate the symptoms it's causing (and the presumed benefit the removal would offer).  You probably could have breast augmentation at the same time, but that would not be a covered procedure.  Your surgeon could probably do both at the same time but there would be a separate fee for the cosmetic portion of the procedure (ie, the breast augmentation).  You should, of course, make sure that you understand clearly what your financial obligation would be for such a combined procedure.

	I hope that this helps and good luck,

	Dr. E

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