How do I get OHIP to pay for explant and capsulectomy?

Question

I have many issues with my implants. They are 20 years old and the pain and health issues I've been having is getting out of control. They are making me very sick. I spoke to my plastic surgeon and i have scar tissue building on the left breast so full capsulectomy needed.

Shaher W. Khan, MD · Answer

Hello, thank you for your question. I am sorry to hear that your implants are making you feel sick. In Ontario, OHIP (Ontario Health Insurance Plan) does not typically cover the cost of breast implant removal (explant) unless it is deemed medically necessary. However, if your implants are causing significant health issues, such as infection, ruptures, or severe complications like capsular contracture (which you're experiencing with the scar tissue buildup), you may be able to make a case for coverage. Please see the attached video to answer your question in detail. I recommend continuing to work closely with your surgeon, providing detailed documentation, and following up with OHIP for more information on how to proceed with the claim.

Ryan Rebowe, MD · Answer

Many, but not all insurances, will pay for implant removal (with or without capsulectomy) but will not pay for additional procedures such as a breast lift, implant replacement, or fat grafting. Not pursuing other options may increase your chances of coverage, but overall it is very depending on your individual insurance plan.

Sean T. Lille, MD · Answer

Dear Powerful867520, 
Here in the United States, it is very rare for insurance to cover explant when breast implants were placed for cosmetic reasons. You could continue to submit as much documentation of your symptoms as you can to see if an appeal would rule in your favor, but odds are not good. You may need to look into financing the surgery yourself. Your health is worth it.  Best of luck to you!!

How do I get OHIP to pay for explant and capsulectomy?

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How do I get OHIP to pay for explant and capsulectomy?

Answers (3)

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Recommended reading

Everything you need to know about Breast Implant Removal

Our mission is to create a world where every investment in modern beauty is Worth It.