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

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.

Doctor Answers 8

Axillary breast tissue

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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.

Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Removal of Axillary Breast Tissue and Breast Augmentation?

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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 “authorization” 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.

Breast Reduction - Insurance Coverage

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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

Can insurance pay for removal of breast tissue on armpit while I have a breast augmentation at the same time?

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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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Combined Cosmetic and Reconstructive Surgery

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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).

Axillary breast tissue and breast augmentation

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

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Excision of axillary mass at the time of breast augmentation

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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.

Axillary breast tissue and breast augmentation

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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.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

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.