Rash/sores from Very Saggy Breasts? Possible for Insurance to Cover Lift? (No Reduction)

My breasts are small and extemely saggy.(After breastfeeding 3 children) They are literally only hanging skin. When I wear a bra they kind of just roll/crumple up into the bra. It is causing me to have weepy,oozing painful areas on my areolas from the skin rubbing on skin. Is it possible that insurance might cover a lift, no implants or anything, just to remove some of the extra loose skin, since it is causing me sores and pain? Or are they likely to call it cosmetic? Thank you very much?

Doctor Answers 9

Insurance Coverage for Ptotic Breasts

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Thank you for the question.

It is extremely unlikely that insurance companies will cover breast lift surgery for any reason. You are correct in that it would be considered cosmetic surgery,  and not "medically necessary".

Based on your description, it sounds like you have a relatively severe degree of breast ptosis.  Please make sure your consulting with well experienced board-certified plastic surgeons.

Best wishes.

Rash under the greats

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Whether your insurance will cover to cost of great lift because you have an intertriginous rash is doubtful but you never know.  It is worth calling your insurance company and trying to get surgical per authorization with a letter and photos sent by your surgeon to the insurance company.  It doesn't cost anything to ask, but the odds are that it would not be covered. Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 28 reviews

Unlikely insurance will cover

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I have tried in the past to obtain pre-determination for a breast lift that is non cancer related and was unsuccessful.  It is highly unlikely your breast lift would be covered by insurance.  See several surgeons however and you might find someone sympathetic to your needs and offer you an excellent price for your surgery because of your need.  I know I have done that in the past. 

Breast lift

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A breast lift is a cosmetic procedure, it is not covered by insurance. Sometimes breast reductions are covered and of course breast reconstruction is always covered.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Insurance coverage for breastlift

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Insurance plans do not cover breastlift despite the fact that you may have symptoms that are identical to a woman pursuing breast reduction, which often is covered by insurance (as long as the requested amount of tissue is removed, determined by the insurance company). I see many patients who have lost significant weight resulting in symptomatic sagging and deflation of the breasts. In my experience, insurance plans do not pay for a lift or implants, but you should explore the procedure if you are interested. It may be that it's not as expensive as you think, and financing may be available. Would you rather spend money on a vacation or on yourself, for results that will last you the rest of your life, beyond 1 week of pleasure? That is one way to look at the question practically.

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.8 out of 5 stars 57 reviews

Breast lift coverage based on rashes

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Insurance company would not cover a breast lift based on dermatologic complaints. They will, however, pay for dermatology treatment for the rashes. Insurers have very strict, cause and effect based criteria. Whether they are rational or not, unfortunately, isn't the issue. These criteria result in denials even when there can be underlying medical problems. However, they are now denying breast reductions with infra-mammary intertrigo so a lift would have even lower standing with them.

Rash/sores from Very Saggy Breasts? Possible for Insurance to Cover Lift? (No Reduction)

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Always worth a try but usually need breast tissue removed to be an insurance covered benefit. Posting photos helps us respond. See in person a few boarded PSs in your area of Colorado. 

Unlikely for insurance to cover a breast lift despite skin breakdown issues

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I'm afraid your insurance provider will not go for a medically needed breast lift. You can certainly attempt at having it approved by having your primary care physician document ptotic breasts as the primary cause for your skin issues. Document, document, document!

If unsuccessful with this quest, look into finacing a lift yourself. The Ultimate Breast Lift is a technique that will lift and reshape extremely ptotic breasts without implants. There is no vertical scar associated with this technique and it works for all breast types. Good luck and best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.5 out of 5 stars 229 reviews

Saggy breasts and rash

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In my experience I have never seen an insurance company cover a breast lift for any reasons. Even coverage for reductions is based on height and weight normograms.

Morad Tavallali, MD, FACS
Vienna Plastic Surgeon
4.7 out of 5 stars 30 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.