Reviewed By: Pramod Kerkar, MD, FFARCSI

Any woman who is suffering from an aggressive form of breast cancer or anyone who is highly prone to developing a breast related disease may choose to undergo a mastectomy. Mastectomy is the procedure where surgically one or both the breasts are removed. Some patients may choose to undergo the procedure of reconstructing the breast after the mastectomy to restore the breast in its original shape and form. During the process of breast reconstruction, breast tissues, breast skin or a nipple which was removed during the mastectomy is replaced. Breast reconstruction surgery can take place soon after the mastectomy has taken place and if you have to undergo radiation as a process of your treatment, you will be suggested to go for breast reconstruction surgery after the radiation period is over.

Breast implantation is done using saline or silicone, the process being known as flap procedure. Both the surgeries are very complex in nature and more than one breast reconstruction surgery may be required in order to position the breasts accurately. The average cost of the breast reconstruction is 16,125 USD including the choice of surgeon, geographic region and the complexity of the procedure or how many times the procedure needs to be done to perfect it.

Is Breast Reconstruction Surgery Covered By Insurance?

Is Breast Reconstruction Surgery Covered By Insurance?

If you are undergoing a breast reconstruction surgery procedure, it should be covered by the health insurance plan. The health insurance plan must help you carry out this surgery if you undergoing it soon after the lumpectomy or the mastectomy or few years later. The health insurance is also supposed cover any refinement that is to be made to the reconstructed breast or any surgery to create balance or symmetry between the two breasts, according to The Women’s Health and Cancer Rights Act of 1988, any group plan is supposed to pay for mastectomy and also cover all the expenses required for any kind of reconstructive and prosthetic procedures which are required. Along with the surgery, the coverage for medical treatments may vary from one state to another. Sometimes the government and the church sponsored health care treatment; the reconstruction procedures may not be included hence before signing up for any plan, you must consult with your plan administrator.

The state and the federal laws demand the breast reconstructive surgeries are covered by the insurance. The insurance may not cover the affected breast, but the contralateral breast in order to gain symmetry again. Breast reconstruction include stages like tissue expanders, breast implant placement, status of the implant post the expansion, transfer of autologous tissue and nipple-areolar reconstruction. All the above stages should be covered by insurance.

What Do You Need To Look Into While You Are Using The Insurance For The Breast Reconstruction Surgery?

There could be enough number of problems that you will come across even when your breast reconstruction surgery is covered by the insurance. Some of the problems include you opting for a newer process of breast reconstruction, if you have to make a more balanced appearance, if you have to undergo a surgery to correct the entire reconstruction procedure you had gone through or if you want that the reconstruction surgery of yours should be performed by a plastic surgeon who is not included in the network of the insurance plan.

You need to communicate with the provider of your plan up front and be updated about what exactly your insurance covers so that you do not have pay anything later unexpectedly. The administrator in the office of your plastic surgeon will help you find out the exact amount that will be covered by the insurance plan. The state health insurance agency and its commissioner would help you further to include the breast reconstruction as a part of the insurance coverage.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: May 29, 2018

This article does not provide medical advice. See disclaimer

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