What is the Cash Cost for a Bilateral DIEP Flap Breast Reconstruction?

Question

I had a bilateral mastectomy prophylactically almost 10 years ago. The implants remain fairly soft, but one has 'bottomed out', causing a significant amount of pain and discomfort. It makes wearing a bra impossible, as the underwire doesn't stay in place, and exercise is even more uncomfortable. Since insurance is very unlikely to cover a second reconstruction for 'pain' complaints. I am considering implant replacement vs diep procedure. What is the ballpark cost of a bilateral diep?

Mark A. Schusterman, MD, FACS · Answer

Dear Loriliz - the cost for this surgery including hospitalization would be very prohibitive for most people...most likely close to six figures. Your insurance company should cover the surgery without question. I switch out breast implant reconstruction for DIEP's all the time and have never been turned down by an insurance provider.

Paul Gill, MD · Answer

Thank you for your question.   The wonderful news is that federal law mandates coverage of reconstruction and subsequent procedures.   I frequently see patients who are dissatisfied with their old implant reconstructions and desire to use their own abdominal tissue to reconstruct the breast.

	I have never had issue in regards to the insurance company covering this revision procedure.   I would recommend consultation with a board certified plastic surgeon with expertise in DIEP flap reconstruction.

	Dr. Gill

Steven Wallach, MD · Answer

Breast reconstruction is usually covered by insurance. Check it out first. Some surgeosn do not "take insurance" and the patient pays "out of pocket."

Jeffrey Zwiren, MD · Answer

If you are having problems with your breast reconstruction using implants and are interested in using autologous tissue such as a DIEP flap most insurance companies will approve this procedure. Your next step is to go to a plastic surgeon experienced with the procedure and have an examination and consultation.

Samir Shureih, MD · Answer

Your insurance should pay for the revision breast reconstruction and that should include DIEP flap if that is what you want

C. Bob Basu, MD, MPH, FACS · Answer

I would not rule out insurance coverage for a Bilateral DIEP flap procedure.  My suggestion would be to visit with a board certified PS experienced in DIEP flap breast reconstruction to see if 1) you are a good candidate for DIEP flap reconstruction and 2) process the procedure for insurance coverage.   In my experience, given your post mastectomy defects and history of a prophylatic mastectomy, I have not had problems getting a bilateral mastectomy reconstruction with DIEP free flaps covered by insurance.  At the very least, its worth a try to secure insurance coverage.  And feel free to visit a provider out of state with experience with this.  The self-pay option for DIEP flaps can be very expensive, especially with the longer operating room time costs and postoperative hospital stay costs.   Best wishes.

	Dr. Basu

	Houston, TX

What is the Cash Cost for a Bilateral DIEP Flap Breast Reconstruction?

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