Would insurance cover a BA if I have pectus carniatum?

Question

I suffer from pectus carniatum and I was wondering if insurance would cover a BA to make me feel "normal" . If so , is it a hard process? Do you pay first and they reimburse? I know it's different with every insurance but what's more common? Would our surgeon help with the process? I can't afford it and I know this will help me psychologically. Thank you!

Tom J. Pousti, MD · Answer

Thank you for the question.  It will be best to check directly with your insurance company to see whether surgery to improve chest wall concerns are considered a cover benefit;  in my experience, unless the chest wall concern is causing a functional problem,  reconstruction of any kind is unlikely to  be considered a "medically necessary" procedure. Generally speaking, breast augmentation surgery may be a great way to help camouflage chest wall concerns/asymmetry.  In other words, with a well executed procedure (carefully positioned  breast implant "pocket" and careful selection of breast implant size/profile), the area of "protruding bone" will likely be covered nicely (you will find a representative case on a recent review posted to our profile: "pectus carinatum coverup").

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Ronald J. Edelson, MD · Answer

Pectus deformity may well be covered under your insurance if the deformity is severe or if there needs to be some work done on your sternum to correct the problem.  Most cases, however, are not severe enough to be covered by your insurance.  You can always ask your plastic surgeon to try for preauthorization.

Edwin C. Pound, III, MD · Answer

While it may be an anatomic anomaly, a  pectus carinatum or pectus excavatum is not a functional problem.  Insurance will not cover breast implants because of this condition.

Vincent N. Zubowicz, MD · Answer

It never hurts to ask but I am doubtful insurance would cover breast augmentation For chest wall abnormality. Your plastic surgeon can inquire about this for you.

Michael B. Tantillo, MD · Answer

I would suggest that you first call your insurance carrier and ask if it is a "covered benefit".  If yes, then tell your surgeon's office this when you make the apointment (some surgeons do not take all health insurancce plans and others take none at all).  If it is not a "covered benefit" then no matter how compelling the argument may be, the plan will not pay for the surgery.

Would insurance cover a BA if I have pectus carniatum?

Answers (9)

Answer: It is highly unlikely insurance will cover breast augmentation for a chest wall abnormality.

Answer: It is highly unlikely insurance will cover breast augmentation for a chest wall abnormality.

Answer: Start with your insurance company

Answer: Start with your insurance company

Recommended reading

Everything you need to know about Breast Augmentation

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

Would insurance cover a BA if I have pectus carniatum?

Answers (9)

Answer: It is highly unlikely insurance will cover breast augmentation for a chest wall abnormality.

Answer: It is highly unlikely insurance will cover breast augmentation for a chest wall abnormality.

Answer: Start with your insurance company

Answer: Start with your insurance company

Browse related questions

Recommended reading

Everything you need to know about Breast Augmentation

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