Will Medicare pay for breast implant removal if ruptured?

Thank you for your question.   Please contact your local Medicare office.  They will tell you the Board Certified Plastic Surgeons that are on their panel.   I would then see the Plastic Surgeon.  They can submit the case and Medicare will determine if it is medically necessary.  If they determine that it is medically necessary they will cover the procedure.  They typically do not cover implant issues if placed for cosmetic reasons.  You have a better chance with coverage if they were placed for reconstruction or, if they are ruptured gel implants placed before 1992, (old style silicone).   The other issue is that Medicare does not give pre-approval, so the decision of coverage is made after the operation is done.   Best to see an experienced, Board Certified Plastic Surgeon.  Together you will work out a plan.Jeffrey J. Roth, M.D., F.A.C.S.Board Certified Plastic SurgeonLas Vegas Plastic Surgery

Hello and thank you for your question.   Typically , implant removal is not covered by insurance if they were placed for cosmetic purposes.   Meet with a Board Certified Plastic Surgeon and discuss options with anesthesia, local may be possible.  

Insurance may pay for the removal of a ruptured silicone implant if it is the old style of silicone.  Proof of rupture is often required.  A ruptured silicone implant should be removed along with the capsule under general anesthesia.  Visit with a board certified plastic surgeon in your area to learn more.

Thank you for your question. Insurance companies typically pay for medically necessary procedures. The rupture of the breast implant in most cases is considered medically necessary. Removal should be covered by your insurance company and you need to work with your plastic surgeon who advocates this on your behalf with your insurance company. What would not be covered is the replacement with other implant for cosmetics. 

Medicare may cover the cost of removing old ruptured gel implants, however, Medicare does not give prior approval. Removal is best done under general anesthesia so that the old capsule and gel may be removed as completely as possible. I would suggest meeting with a board certified plastic surgeon and discussing all your options.

generally speaking insurance will not cover removal of implants that were placed for cosmetic purposes. Depending on the situation is MAY be possible to remove a ruptured saline implant under local anesthesia in an office setting, but it is not likely that a ruptured silicone implant can be safely or effectively removed in an office setting.