When is a breast lift considered medically necessary? (Photos)

Question

I recently had my botched 1400cc saline implants ruptured in office with my Medicaid insurance covering the removal. Working with my insurance they would cover a lift if medically necessary. The only surgeon in my area that accepts insurance procedures doesn’t feel my lift is necessary and quoted me over 8k for the lift. I’m not fighting with insurance but the surgeon on what’s medically necessary. Can I have some insight so I can advocate for myself and not get taken advantage of again?

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Sorry to hear about your problems. I feel that you are in for a bit of a disappointment. I am shocked that your insurance covered removal of the implants at all unless there was pain or some other medical reason to have them removed that qualified as “medically necessary.” That being said, there really is no such reason that would justify the lift. In other words, if you do not have the lift, it is not going to alter your overall health or put you at risk. Your surgeon is not wrong. I think that your quote from him/her is completely reasonable for a lift and furthermore, you need to consider the significant risk of a lift in your case because an overfilled implant like that significantly thins the soft tissue and makes a lift at very high risk of wound healing problems or necrosis. And that is not to mention the concerns about the cosmetic appearance of the outcome. Hope this helps and best of luck!

Camille Cash, MD · Answer

A breast lift is considered cosmetic and is not covered by insurance.  Sometimes a breast reduction, which includes a lift as part of the procedure, is covered by insurance if certain criteria are met.  Typically patients must prove that the situation is causing medical problems and that non surgical methods, medications, and/or modalities have been used to improve the situation without success.  Regardless if your surgeon determines that your situation is medically necessary, the insurance company is the entity that will approve or deny the payment for the procedure.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Unfortunately although your breast tissues do not look aesthetic following the implant removal, a lift is for cosmetic purposes and not medically necessary.  I agree with your initial surgeon, and his pricing is reasonable for that operation.

Daniel Barrett, MD · Answer

Dear Persistent605087,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jane M. Rowley, MD · Answer

Breast augmentation and breast lift are always considered cosmetic.  Your breasts don't look very good but they don't cause back pain or any other medical sequelae. Even with your extraordinarily large implants the problem is, you chose to do that to your body.  I am sorry that someone did not advise you to stay with smaller implants to begin with.  And, 8,000 for a breast lift in your case is a very reasonable price.  I am sorry fo the situation you are in, but try to choose a surgeon Board certified by  THE AMERICAN BOARD OF PLASTIC SURGERY.   I would also try to find someone who has experience with difficult revisionary procedures.  Good luck to you, Jane Rowley

When is a breast lift considered medically necessary? (Photos)

Answers (6)

Answer: Breast lift

Answer: Breast lift

Answer: Cosmetic breast procedures

Answer: Cosmetic breast procedures

Recommended reading

Everything you need to know about Breast Implant Removal

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

When is a breast lift considered medically necessary? (Photos)

Answers (6)

Answer: Breast lift

Answer: Breast lift

Answer: Cosmetic breast procedures

Answer: Cosmetic breast procedures

Browse related questions

Recommended reading

Everything you need to know about Breast Implant Removal

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