Would insurance cover a BA if I have pectus carniatum?

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!

Doctor Answers 10

Would insurance cover a breast augmentation if I have pectus carniatum?

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. 

 

Start with your insurance company

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.

Michael B. Tantillo, MD
Boston Plastic Surgeon
4.7 out of 5 stars 29 reviews

Pectus Carnatum insurance

Thank you for your question, 
for information purposes:
plastic surgery has two major divisions(with overlap)
1)reconstructive plastic surgery: takes abnormal to normal
2)!cosmetic plastic surgery:, takes  normal to better than normal
In your case, this is where overlap can occur.
Do yo have any functional or restrictions from your chest?
If so you must see your primary care physician and get a referral.
then based upon what is found, and the surgeons report your case will be evaluated for its merritt. You can always appeal.

good luck in your journey

Pectus carniatum and breast augmentation

Thank you for your inquiry about breast augmentation and correction of pectus carniatum.

A consultation with a plastic surgeon would be needed to determine if a breast augmentation would be the best treatment. 

If it is, insurance may not pay. It is likely to take the position that although it is a developmental problem, the correction you want is for appearance only - not for functional reasons.

Your plastic surgeon may be willing to submit a 'pre-determination' request to your insurer but there may be a fee. Depending on whether your plastic surgeon participates in your insurance (increasing few do), you will be required to pay the full fee in advance or only do-pays and deductibles if insurance agrees to pay for the surgery. Otherwise you pay the full fee in advance, regardless.

Recovery is usually a matter of days - implants placed under the muscle cause more pain but it usually subsides by day 5. Best wishes







Insurance for pectus deformity

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 25 reviews

Pectus Carinatum

As stated by others, insurance will never pay for a cosmetic procedure. Yes, with implants the Pectus Carinatum will be less noticeable since the breast projection and sternal projection are relative. Also, not sure what the definition of "normal" is. We are all different in one way or another. I would not be so hard on yourself.

Scott R. Brundage, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 23 reviews

Pectus

Insurers will typically pay only for "medically necessary" surgical procedures, and breast augmentation is pretty much universally considered cosmetic.  The only common exception is for surgery after breast cancer treatment, and that is required by legislation, not by choice of the insurers. 

Sorry not to have a more favorable response for your.  All the best.  

Breast augmentation and pectus carinatum

Thank you for your question. Typically insurance companies will not cover breast augmentation to treat pectus carinatum because it is usually a cosmetic issue rather than a functional issue. I would try and find a board certified plastic surgeon in your area and have them evaluate you to determine what options you have. Good luck.

Arun Rao, MD
Tucson Plastic Surgeon
5.0 out of 5 stars 15 reviews

Pectus carinatum

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.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

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

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 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.