I have Poland syndrome and I'm considering implants. Would insurance cover the procedure?

Question

I have polands syndrome and I'm considering implants. Would insurance cover the procedure? Also, is there anything specific to an augmentation for a Poland syndrome patient?

Leila Kasrai, MD, FRCSC · Answer

Insurance does not generally cover breast augmentation, even for patients with Poland Syndrome. However, you should speak with your provider as your plan may be different.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Daniel Barrett, MD · Answer

Dear asmith2088,
it is unlikely that insurance will cover the costs of BA even if you have Poland syndrome. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Contact your insurance company and see what is covered. If covered, you will need a referral from your primary care physician. Most patients are able to get implants placed in front of the muscle on the opposite side since the muscle does not exist or is very minimal on the affected side. Occasionally, a muscle from the back can be rotated around, but that will leave a scar on your back and missing a muscle.

Camille Cash, MD · Answer

It is doubtful that insurance would cover breast augmentation surgery for someone with Poland Syndrome.  It is considered cosmetic and therefore rarely covered except in circumstances like breast cancer reconstruction. It never hurts to ask your insurance carrier though just to be sure.

Steven Schuster, MD, FACS · Answer

I have never seen Polands syndrome covered by insurance in this day and age when the goal of insurance is to deny!  The key is to find a plastic surgeon with a good deal of experience in handling revisionary surgery as well as complex breast procedures like Polands and Tubular breast deformities.  Since this is an over the muscle procedure I would consider using cellular dermal matrix (ADM) or mesh to help with support and to hopefully lower capsule rate.  Your surgeon should have experience in using these products.  I have found best results with ADM for this.  Good luck in your surgery and you can always ask your surgeon to try to get pre-authorization.  Dr. Schuster in Boca Raton Florida

Mats Hagstrom, MD (license on probation) · Answer

It is unusual for insurance companies to cover breast augmentation surgery.
Each insurance plan is based on a contracted agreement between the carrier and the provider.
You can contact your insurance company and see if the condition is a covered benefit.
We can also ask plastic surgeons to request insurance authorization. Recognize insurance reimbursement for cosmetic surgical procedures is generally only small fractions of what standard fees are. Requesting insurance authorization can be time-consuming, and some plastic surgeons may or may not be willing to do this for you.
Some plastic surgeons are also not willing to accept insurance reimbursement because it is simply too low to sustain practice.
There are many different versions of Poland syndrome.
To make an assessment would require an examination.
I suggest scheduling a few in person, consultations with plastic surgeons in your community to see what they have to say.
You may want to consider plastic surgeon, who have a strong history of being involved in breast, cancer reconstruction or reconstruction in general.
Some plastic surgeons simply don’t do insurance based reconstructive work.
If you have an academic Medical Center near you, that may be a good place to check out.
Best,
Mats Hagstrom, MD

I have Poland syndrome and I'm considering implants. Would insurance cover the procedure?

Answers (7)

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