Will Tricare Cover Breast Augmentation for Asymmetry Following a MRSA Infection?

Last year, while breast feeding my first child, I developed a severe case of mastitis which then turned into a MRSA infection and had to have tubes placed in my right breast to drain the infection. Then, I developed a milk fistula which took months to heal. As a result, my breasts became noticeably asymmetrical, and now, with my second child, it has become significantly worse. Will Tricare cover a breast augmentation based on this?

Doctor Answers 5

Insurance Coverage for Asymmetry

I would suggest that you contact your physician to determine how much damage was caused by the MRSA. I would then contact a reputable board certified plastic surgeon to determine your treatment options. A letter should be written to your insurance company for pre-certification prior to having any procedure. Best of luck!

Columbus Plastic Surgeon
4.7 out of 5 stars 34 reviews

You need to ask your insurance company

You breasts are very different in size and shape and the solution is not augmentation only. You will need lift and fat grafting to the right breast for symmetry and lift only for the Left breast.

The insurance coverage will depend on the coverage and company.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Health insurance

Whether or not your health insurance will cover the procedure depends on the wording of the policy. If you were born this way it is doubtful that they would. If there is a clause in your policy stating they cover deformities arising from infections or trauma and you can prove the breast asymmetry was not there before the infection they will have to cover it. However their coverage will then be limited to getting you closer to what you were before the infection. You will need to have your surgeon write a letter of pre-authorization to the insurance carrier and describe your situation accurately. If they respond affirmatively you could then proceed with surgery paying less out of pocket.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Ask the insurance company

It is your insurance company, ask them. In my experience, insurance covers very little that can be deemed cosmetic.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Will Tricare Cover Breast Augmentation for Asymmetry Following a MRSA Infection?

Very very doubtful. But call, write, e/mail TRICARE with your issues and see a providing PS for them to obtain a definitive answer. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.