Breast Implant for DRASTIC asymmetry- covered by insurance?

Hello,As others have mentioned, it is probably unlikely that you can get coverage for breast augmentation related to your asymmetry. I would recommend that you check with your primary care physician though- see if they know of a way to help you and meet with a board certified Plastic Surgeon for assessment and planning. If you cannot receive insurance coverage, you may still decide to proceed with augmentation, ( or lift/reduction) and you could apply for financing to help you offset the cost.All the best

Hello, I think you would need to check with your insurance company to clarify their policy regarding severe breast asymmetry.  In my region (Ontario) sometimes it is possible to get coverage to make one breast larger or smaller.

I'm sorry to read about your discomfort, but thank you for your question. It sounds to me like something that could be considered reconstructive and submitted to insurance, however coverage generally depends on your insurance plan and benefits. The first step is to contact the member services phone number on the back of your insurance card in order to locate and consult with a participating surgeon within your area. It's best to bring along any office notes from your primary care physician and chiropractor to support your medically necessary claim. Best of luck!

In Canada , coverage for breast assymetry is dependent on the province you live in. In British Columbia, you would likely be insured for reduction of the larger breast, but not augmentation of the smaller one. A balancing mastopexy may be covered by insurance, but this is on a case-by-case basis. 

Unfortunately, it is highly unlikely that an insurance company will cover implant for breast asymmetry. Best of luck.

The chances are unlikely that insurance will help you with breast asymmetry. You can though meet with a board certified plastic surgeon and consider an insurance predetermination. This is the way to know just how things will stand with them.

In my experience and opinion, I doubt seriously if you can make a strong enough case with any of the current insurance carriers that the problems that you describe should be covered by them.  I am definitely sensitive to your concerns and your strong desire to make the changes to your breasts that you wish, and I definitely think you should look into that, but I don't want to mislead you at all into thinking that you have a high probability of succeeding in the insurance game.  This is because most insurers view things like breast asymmetry and small breasts as being more of a "cosmetic issue."  Unless we are talking about severe deformities, like we see in things like Poland's Syndrome, where the breast doesn't form at all, it is very hard to get them to accept such cases as "reconstructive," "medically necessary," or any other term that means worthy of coverage by insurance.  After sitting on boards of utilization review and quality assurance for insurance companies, as well as struggling for years myself to get such cases covered for my patients, I finally gave up and stopped taking insurance!  If you are interested in pursuing this, the best thing to do would be to find all of the plastic surgeons in the network of your insurance company and make some appointments with some of  them.  They will need to evaluate you carefully, and the key thing that they will need to find is that your breast deformities create a sufficient "departure from the normal anatomy" that the case should be considered reconstructive and medically necessary.  If a surgeon can come to that conclusion, then he can submit a request package for authorization to the insurance company, and then you'll see if they will accept it.  Be prepared for them not to, however, and if they don't, I would still inquire with the surgeon about how to go about getting the surgery at your own expense, because it sounds like something important to you, and for that reason alone it is worth considering.  Good luck.

That is terrible you have had so many issues.  Without pictures it's difficult to conjecture on your issue.  You should schedule a consultation with a board certified plastic surgeon for a thorough examination and consultation.  If your orthopedic issues are the result of your breast asymmetry, there may be some way through.  As well, there are conditions that contribute to the malformation of one side of the chest.  These conditions are considered deformities and can be covered by certain types of insurance. I'm sorry you're suffering and wish you all the best in getting your issues resolved.

Thank you for your question. Insurances can be difficult to deal with especially since virtually none of them have any desire to pay for any conditions in the first place. This would include cosmetic surgery in which most insurance companies would consider any deformity that was not medically necessary a cosmetic condition, therefore, making it an out of pocket expense. Ironically, with the change in affordable healthcare, many insurance companies have deductibles that are so high that it turns out to be often less expensive to simply schedule procedures as cosmetic.Without seeing your photographs, it is difficult to ascertain the specifics of your condition, however, your situation is not uncommon and usually involves enhancement of one breast with a reduction of the other. Breast lift procedures are often combined as well. There are a number of different options that are available. In any case, I would suggest a consultation with a board certified plastic surgeon who is experienced in these matters. In the very least, insurance discussion and options would certainly be available at that time. I hope this helps and have a wonderful day. Dr Kayser - Detroit

I am sorry that you have the misfortune of failure of one breast to develop. With adequate documentation of the back and shoulder pain that does not respond to non-surgical management, you may qualify for a breast reduction covered by your insurance company. However, they rarely will cover correction of the underdeveloped breast. Do you have normal chest muscle function on the underdeveloped side?  If so you may have a condition called Poland Syndrome, which is not serious, but just a misfortune of development. Breast augmentation on the smaller side and reduction on the larger one can give n improvement in your symptoms and look more balanced as well.I would recommend discussing this with a Board Certified Plastic Surgeon who participates with insurance companies and will investigate insurance pre-authorization.  Good luck