Do insurance companies cover revision for breast reduction?

Question

If my breast need a revision after reductuon surgery , how long i should wait after the surgery to do revision? My breasts are not even , still big i was 34dd/ddd now i became 34D all dense on the sides of my breast .im one month post-op now. DONT WANT TO DEAL WITH MY SERGEON ANYMORE HE IS VERY UNPROFESSIONAL. ....is the revision could be covered by insurance companies?

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

The short answer is: Possible but unlikely as Insurance Rarely Covers Breast Reduction RevisionInsurance companies in general are only concerned about solving functional problems (e.g back or breast pain, inability to wear clothes or exercise, etc). They are not concerned about cosmetic appearance and it his highly unlikely that they will cover any revisions for this purpose. I would return to your original surgeon who will likely discount his services if this was related to his surgery unless you have lost confidence in your treatment. If so see a board certified plastic surgeon with experience in breast revision surgery. Only an exam would be able to determine the technique best suited for your revision#breastreduction#breastrevision

Nelson Castillo, MD · Answer

Thank you for your question and I am sorry to hear about the disappointment with your breast reduction.  You are still early out from surgery and best to allow 6months to a year pass in order for your results to mature.  This allows your skin quality to regain its normal suppleness and tone, allows for any residual swelling to resolve, and your scar tissue time to soften. This will make revision surgery easier, safer, and with greater reproducibility of results.  As far as coverage, I would recommend you see an ASPS board certified plastic surgeon for an evaluation.  They can submit information on your behalf to your insurance company to see if your revision would be covered.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

This is a very difficult question. The only way to know if your insurance will cover the procedure would be to submit a pre-authorization. I would give you your first breast reduction at least six months to heal. Seek second opinions from other plastic surgeons.

Sheila S. Nazarian, MD · Answer

I am so sorry that you aren't happy with your results. First, wait at least 6 months before considering breast reduction revision surgery. Then, yes, seek a consultation with another board certified plastic surgeon in your area to discuss your options. Then, call your insurance company and see if they would cover and if so, what exact criteria would need to be met. Best, Dr. Nazarian

Bram Kaufman, MD · Answer

Thanks for your question. First I am sorry that your results are not what you expected. Occasionally this is the case but there is hope. I have treated a number of patients who have come with uneven or under-reduced breasts after reductions elsewhere. Most of the time (probably about 75%) I have been able to get insurance to cover the revision. The important things to consider are the functional limitations and symptoms/signs that persist. Just as the initial procedure is considered a surgery to address pain, difficulty with hygiene, and skin issues, one needs to demonstrate that at least some of these issues persist. This requires careful documentation from your primary care physician, a list of medications used to treat pain and rashes, an estimate of the additional resection weight of breast tissue needed to achieve the desired result and photographs. Essentially, it will be the same insurance pre-certification process you went through initially. Many if not most breasts are asymmetric naturally and many remain so after surgery. Asymmetry of this degree alone will not likely qualify for revision. I recommend to my patients that we wait at least 3 months before considering revision. This will allow the tissues to stabilize and the inflammation to resolve. The revision will be easier and less risky after 3 months. Hope this helps.Good luck.

Steven Wallach, MD · Answer

Since you recently had a reduction, I would suggest giving it 4-6 months to settle down. An evaluation at that time could be beneficial.  As for insurance coverage, you would have to talk with them to determine whether this would be possible.  Good luck.

Julia MacRae, MD · Answer

I would definitely give it some more time (at least 6-8 mos) before considering more surgery.  At only one month, your scar tissue will still be forming, causing the firmness and density.  Those scars will remodel and soften up at 4-6 months post-op.  Also, it is normal for the breasts to be wider at first, especially on the sides - they will "round up" and drop with time.If after 6 months, you are still unhappy with the appearance, consult some other plastic surgeons to get other opinions on whether further surgery can improve this.   Having a copy of the original operative report will help any surgeon doing revisional surgery on you.  As for whether it will be covered by your insurance, that depends upon the plan.  The plastic surgeon planning to do the operation can help you submit for pre-authorization to see whether it will be covered, or what the fees would be if not.

Robert L. Kraft, MD, FACS · Answer

First, you need more healing tine before a determination can be made on whether revision is necessary. Next, it all depends on the insurance company. In New York, where we have so many plastic surgeons, the insurers seem to be much tougher on reductions in general than in other parts of the country.  Using the "functional medical necessity" standard, the revision may not be covered but each carrier is different and it would require preauthorization.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast reduction surgery. I would suggest that you wait at least six months, preferably a year, prior to evaluating the long-term outcome of the procedure performed and whether or not to proceed with additional surgery. If you choose to proceed with revisionary breast surgery, sharing a copy of your original plastic surgeon's operative report with your "new" plastic surgeon will be helpful. It is possible, but not predictable, that the health insurance company will cover revision surgery.  Direct communication with the health insurance company will likely provide you with the most accurate/reliable information. Best wishes for an outcome that you will be pleased with long-term.

Do insurance companies cover revision for breast reduction?

Answers (9)

More Breast Reduction Questions

WE SEND PRETTY
EMAILS

Answers (9)

More Breast Reduction Questions

Incision gap/separation around nipple. Should I be worried? (Photo)

Can I get a breast reduction before weight loss? My breasts make it impossible to work out without immense pain.

After breast reduction there is no change in bra size/relief from neck & shoulder pain. Please tell me this is swelling? (Photo)

How many cup sizes can you go down safely with a reduction?

Are the hospital & anesthesia fees separate if breast reduction covered by insurance & I'll be paying for tummy tuck & lipo?

One breast swollen and bruised 2 weeks post op Breast Reduction. Any suggestions?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS