Are there medical reasons (medical necessity) to have a brachioplasty? (photos)

Question

Right before I was diagnosed with breast cancer, my upper arms developed "bat wings." In the last few years, they have gotten much worse. (My PCP thinks that each arm has roughly 7 - 8 pounds of fat.) I have recently lost over 150 pounds - I have lost inches ALL over, but not my arms. Arm movement is awkward, I get heat rashes, have upper arm and shoulder pain.

J. Timothy Katzen, MD, FACS · Answer

Yes, there are medical reasons to necessitate an arm reduction or brachioplasty. Over the past 15 years I have had a significant number of patients authorized by their insurance companies for arm reduction or brachioplasty due to redundant, excess upper arm skin and fat. Insurance approval depends on your anatomy, history, medical plan, strength of your plastic surgeon’s letter requesting for arm lift surgery, and the eventual approval by hopefully, a medical doctor in your insurance plan. Please note, however, there are no rules and every insurance plan has their own individual rules. To make matters even more confusing, every state also has independent rules requiring medical coverage for certain conditions. I have often had arm reductions or brachioplasties covered by insurance if the patient can document rashes and difficulty keeping the axillary region clean. In addition, I have been able to get approval from insurance companies for brachioplasty if  my patient can prove that their arms interfere with activities of daily living. I had one patient get authorized for surgery because she was a cook and kept burning her arms on the stove. I had another patient who was required to wear uniform at work. Due to the size of her arms, she could not fit into the required uniform.  Because of this situation, her work insurance had to authorize her arm reduction surgery.Based on your pictures, I would hope any and all medical insurance plans would cover your arm lift or brachioplasty.I hope this answers your question regarding insurance coverage for arm lifts, arm reductions, and brachioplasties.  Good luck! If you have any more questions regarding your arm lift or insurance, please contact my office. Sincerely, Dr. Katzen.

Charles Galanis, MD · Answer

Thanks for your question and the accompanying photos.  Without question you would benefit from a brachioplasty.  Unfortunately, even in the context of pain and frequent documented infections, it has become increasingly difficult to have insurance cover body contouring procedures.  It really varies from insurance company to insurance company but overall the trend is the same.  The best you can do is have a plastic surgeon and your primary provider write letters including ICD-9 (diagnosis) and CPT (planned procedure) codes with photographs to your insurance company and hope for the best.  I am sorry I couldn't be more helpful!   Good luck!

Richard H. Tholen, MD, FACS · Answer

Anatomically, the presence of this degree of upper arm tissue makes brachioplasty the only surgical option appropriate for you (all other health items being okayed first). Your previous breast cancer, unless it was bilateral, appears to have had little or nothing to do with the severity or development of this tissue, nor has it responded to your massive weight loss (congratulations on the weight loss!).As Dr. Burns has stated, axillary lymph node dissection (ALND) may make the risk of lymphedema higher on that side, but the degree of present tissue excess is as much as pretty severe post-surgical lymphedema. I think that brachioplasty is not necessarily contraindicated in the setting of ALND, since the scar is linear, not circumferential. Dissection and undermining need to be limited, and the surgical planning needs to be precise. The potential decrease of tissue load and poor lymphatic flow/drainage in the present tissue excess actually make a relative case FOR brachioplasty, though lymphedema is indeed a consideration.As far as insurance covering brachioplasty, see one or more ABPS-certified plastic surgeons and find out if prior authorization can get approval. Even if not covered, I would consider this a worthwhile investment of your own funds (self-pay) if the rest of your evaluation and work-up make this surgery something to consider. I think there is a possibility that brachioplasty is a good option for you, irrespective of insurance coverage, but would need to examine you and obtain a detailed H&P first. Best wishes! Dr. Tholen

Jonathan Amspacher, MD · Answer

It would be very rare for brachioplasty to be a medically covered procedure. You may want to check with your breast surgeon to see if lymph edema is playing a role in your problem. If he thinks it is the. You may benefit some from lymph edema therapy.

John L. Burns Jr., MD · Answer

With your history of breast cancer, we need to know if you had a mastectomy and axillary lymph node dissection.  If you had an ALND then you are not a candidate for a brachioplasty because of the risk of lymphedema.

Are there medical reasons (medical necessity) to have a brachioplasty? (photos)

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Answer: Is brachioplasty medically indicated

Answer: Is brachioplasty medically indicated

Answer: Brachioplasty

Answer: Brachioplasty

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Are there medical reasons (medical necessity) to have a brachioplasty? (photos)

Answers (10)

Answer: Is brachioplasty medically indicated

Answer: Is brachioplasty medically indicated

Answer: Brachioplasty

Answer: Brachioplasty

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Recommended reading

Everything you need to know about Arm Lift

Our mission is to create a world where every investment in modern beauty is Worth It.