Does Medicare cover explanation of ruptured silicone implants? (Photos)

Question

I've been bed ridden for many years due to all-over body pain, chronic fatigue, memory fog, concentration problems and balance problems for over 20 years. I've had the same implants since Nov. 1988. I had an MRI on 4/13/17, which confirmed the rupture.

Kenneth Hughes, MD · Answer

If the implants were placed for cosmetic and not reconstructive purposes almost 20 years ago, Medicare may not cover their removal.  However, if you and your surgeon can provide documentation that the ruptured implants are contributing to your other health issues, Medicare may cover the removal.  Best to schedule an in-office consultation with your plastic surgeon.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry to hear of your implant difficulties.  I would advocate seeing your plastic surgeon for an in-person examination as each insurance plan under medicare has different benefits and coverage terms while also differentiating between implants placed for cosmetic and reconstructive purposes.  If your implants were placed for aesthetic reasons explantation is unlikely to be covered.  Hope this helps.

Connie Hiers, MD, FACS · Answer

Medicare may cover the removal of ruptured gel implants. I would suggest meeting with a board certified plastic surgeon and discussing your options.

Robert Whitfield, MD · Answer

Please see a Plastic Surgeon who performs breast reconstruction.  They typically continue to take insurance in their practice.  Discuss your insurance issue with the practice.

Robert E. Zaworski, MD (retired) · Answer

If your implants were placed for medical reasons such as cancer reconstruction, insurance may pay for removal since they are ruptured.  Meet with a board certified plastic surgeon for an in person evaluation.

Does Medicare cover explanation of ruptured silicone implants? (Photos)

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Answers (5)

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