Are you wondering if your health insurance will cover the cost of removing your breast implants? Although contracts and rules differ, in general, the insurance company will look at the original purpose for the implants.
- If the implants were placed after a mastectomy and the doctor thinks they should be removed, “If the breast implant removal is deemed “medically essential,” health insurance is compelled to pay for it.
- If the original purpose of the breast implants was to enhance the appearance of healthy breasts, some health insurance companies will fund explant surgery if the services are deemed necessary “Others, however, will not consider it “medically necessary.”
What if my insurance provider says “cosmetic surgery issues” aren’t covered?
Don’t let yourself down. Almost all health insurance coverage exclude “cosmetic surgery” and “cosmetic surgery consequences,” but don’t give up. Many insurance make exceptions for issues from breast implants if they are deemed “medically required” or “reconstructive surgery” in certain instances.
Varied health insurance companies have different definitions for this, and it also differs by state.
Even if the doctor believes that removing the breast implants is medically required, the health insurance policy could refuse to pay if the policy’s definition of medically necessary differs from the doctor’s.
Most of the most generous health insurance coverage for breast implant removal are based on one of the following conditions:
- Baker III or Baker IV capsular contracture is caused by silicone or saline implants.
- Breast implants that need to be removed due to infection or BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma, an immune system disease).
- Rupture: If the implants have ruptured, proof is required. Implant ruptures are best measured with MRIs, however ultrasounds or mammograms may also be used. Mammography, on the other hand, can cause existing breast implants to shatter or leak, and it is not particularly accurate at identifying rupture, so it is best to avoid it.
- Breast implants are a “foreign body,” and most women’s bodies naturally respond by forming scar tissue around the implant inside the body to defend the body from this “foreign invader.” This is a natural occurrence. When the scar tissue around the implants tightens or hardens, it is referred to as capsular contracture. Breast implants made of saline or silicone can cause capsular contracture. It can make you feel a little uneasy or cause excruciating agony. The mildest form of capsular contracture is known as “Baker I” or “Baker II” (after Dr. Baker, who created the classifications), whereas the most severe is known as “Baker III” or “Baker IV.” Breasts that are Baker III or Baker IV are hard and/or painful. Baker III and/or Baker IV level capsular contracture is usually only considered a medically required reason for removal by insurance carriers.
- Chronic Breast Pain: Capsular contracture pain is frequently stated as grounds for insurance coverage of breast excision. Furthermore, if the implants are causing severe discomfort due to nerve damage or the weight of the implants, the insurance company may be able to cover the cost of removal.
Unfortunately, most insurance companies do not consider any autoimmune diseases/symptoms or anxiety related to the implants as indication that removing the implants is medically essential. Many women with those symptoms, however, also have other issues like leaking silicone implants or capsular contracture. Concentrate on the symptoms that the insurance company is interested in, rather than the ones that aren’t covered.
When the objective of the surgery is to remedy a medical condition, some insurance companies will consider breast implant removal “reconstructive surgery” rather than “cosmetic surgery” and thus medically required. This usually indicates Baker grade III or IV capsular contracture, as well as restricted movement that makes it difficult to perform simple actions like reaching over the head. If there are silicone lumps in the breast area that interfere with the identification of breast cancer, breast implant removal may be considered restorative.
When it’s time to approach the insurance company for coverage, Fox Valley Plastic Surgery writes the insurance company a letter explaining why breast implant removal is medically required. The emphasis is on complications that are more likely to be reimbursed by insurance (such as implant rupture or Baker III or IV capsular contracture), rather than symptoms that the insurance company will not pay (such as autoimmune symptoms).
How much does it cost to have a breast implant removed?
How much does it cost to have a breast implant removed? According to the American Society of Plastic Surgeons’ 2020 figures, the average cost of breast implant removal operation is $3,049. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related costs.
Your Insurance Policy
If you’re wondering if your health insurance will cover breast implant removal, the best answer is that it depends on your specific policy. Because every insurance company handles cosmetic surgery procedures differently, and because breast implant removal is considered cosmetic surgery, you’ll need to examine your plan’s list of covered benefits to see how much, if any, your insurance company will pay for this procedure.
Locate your “Evidence of Coverage” document, often known as a “Benefits Booklet,” to find your insurance company’s particular policy on breast implant removal. This brochure spells out exactly what is and isn’t covered by your plan. You’ll want to check for information about breast implant removal if your firm doesn’t provide it, but if it doesn’t, look under “Beauty surgery.” Also, look up the definition of in your plan “Medically required.”
General Policy Guidelines
Despite the fact that you should check with your particular insurance company to see if breast implant removal is covered, there are a few basic ways that the majority of insurance companies pay this treatment. First and foremost, your insurance will want to know why you had breast implants in the first place. This will serve as the beginning point for determining whether the removal operation will be covered.
Implants After a Mastectomy
If you had your breast implants placed after a mastectomy to remove your natural breasts, your insurance company may be compelled to pay for their removal. Your doctor must believe that removing your implants is medically required and must be able to persuade your insurance company that it is. This means that there is a medical reason to have them removed that will improve your health or cure a condition caused by the implants.
Implants for Augmentation
Even if removal is deemed medically necessary, your insurance company may or may not cover your breast implants if you received them for augmentation purposes. This is due to the fact that many insurance companies do not cover cosmetic surgery or its repercussions. As a result, no matter what explanation you offer for having your breast implants removed, they will not provide coverage, even if they are making you unhealthy or causing other medical problems.
Exceptions
Do not give up if your insurance company initially rejects your claim for breast implant removal. Many insurance companies make exceptions to their policy for complications from breast implants (as opposed to other cosmetic surgical treatments) if they meet certain criteria or are judged medically necessary under reconstructive surgery restrictions. This will necessitate the collaboration of your physician in establishing medical necessity with the insurance company, as the latter will require documented verification of the requirement.
Medically Necessary Conditions
As previously stated, the word “medically necessary” refers to a physician’s decision to perform a surgical operation based on reasonable, evidence-based standards of care. However, each insurance company defines this term differently in order to comply with state laws about which operations health insurance companies must cover by law. Keep in mind that insurance companies are in the business of making money, so getting borderline medically required operations approved isn’t always straightforward.
It’s also crucial to understand that even if your doctor thinks your breast implant removal operation is medically necessary, your insurance company may disagree and refuse to pay for it. Health insurance plans that have previously covered for breast implant removal have determined that the treatment is medically required based on one or more of the symptoms listed below, which must also be documented by your physician.
Ruptured Silicone Gel Implants
Despite the fact that ruptured silicone gel implants are not thought to cause breast cancer or other significant problems such as infertility or rheumatoid arthritis, they can cause excruciating breast agony. If you detect lumps, hardness, or swelling in your breast, or if the form or size of your breast changes, it’s possible that one of your implants has burst. However, there are situations when there are no symptoms at all.
Your doctor will need to provide you confirmation of a burst implant, which will most likely come in the form of an MRI or ultrasound. A mammogram may be able to detect a rupture, but because mammograms can cause previous implants to rupture or leak, or exacerbate a present leak, an MRI or ultrasound is a superior diagnostic technique. Your doctor will almost certainly need to establish that the leak is causing you medical problems as well.
Baker III or Baker IV Capsular Contracture
The most common consequence of silicone or saline breast implants is capsular contracture, which causes pain, hardness, and numbness in the breasts. Scar tissue builds around the implants as your body’s natural response against a foreign substance, causing this. A grade three capsular contracture is characterized by firmness, misshapenness, and discomfort in the breast. The breast is rigid, deformed, and painful with a grade four capsular contracture.
Capsular contracture grades one and two are usually not regarded medically required grounds to remove breast implants. The breast will be supple and a grade one capsular contracture will be scarcely apparent. The breast is slightly firmer in a grade two capsular contracture, but there is no pain or discomfort. Chronic pain from capsular contracture (grades III and IV), especially if it’s causing nerve damage, is a common justification for implant removal when it’s medically essential.
Infection or Breast Implant-Associated Anaplastic Large Cell Lymphoma
You may need to have your implants removed if you get an infection in your breasts as a result of your implants, or if you develop a condition known as Breast Implant-Associated Anaplastic Large Cell Lymphoma, or BIA-ALCL. BIA-ALCL is an uncommon type of immune system cancer detected in the scar tissue surrounding the implants. It is not breast cancer. It has the potential to spread to lymph nodes and, if left untreated, can be lethal.
Not Medically Necessary
While insurance companies differ in what they consider medically necessary, what is not medically necessary is obvious. Breast implant removal procedure is usually not covered by insurance if it is causing autoimmune disease symptoms or anxiety. Recent research suggests that people who have breast implants have a higher frequency of autoimmune illness diagnoses than those who do not have implants. Lupus, scleroderma, and rheumatoid arthritis are among them.
Most insurance companies are unaware of the potential relationship between autoimmune disorders and breast implants because the link is currently shaky, despite the fact that it has a name (Breast Implant Illness). This ailment has no diagnosis code, so it cannot be claimed on a medical bill. However, many women who have BII or anxiety due to breast implants also have another problem like as a leak or capsular contracture, which may be covered by insurance.
Reconstructive Surgery vs. Cosmetic Surgery
If your physician suggests the removal of breast implants due to a medical condition, this type of removal would be considered as reconstructive surgery rather than aesthetic surgery and would be reimbursed by your insurance carrier. The most common medical problem associated with breast implants is pain or significant movement restrictions. It’s likely that getting your breast implants removed because they’ve gotten deformed is still considered cosmetic surgery.
If there are silicone lumps that are interfering with the capacity to diagnose breast cancer, reconstructive surgery rather than cosmetic surgery may be recommended. This is especially true if you have signs of breast cancer but a mammography can’t “see” through the silicone or if the silicone is blocking medical professionals from taking a biopsy from a probable tumor. Your doctor may advise you to have your implants removed to avoid a more serious problem.
Is an explant covered by insurance?
Breast implants can significantly improve a woman’s life. Breast implants are used by roughly 10 million to 11 million women worldwide, according to the American Society of Plastic Surgeons and the Plastic Surgeon Foundation. According to the American Society of Plastic Surgeons, over 400,000 women and teenagers have breast implant augmentation procedures each year, with 75% of them for enhancement of healthy breasts and 25% for reconstruction after mastectomy.
Women have suspected that their breast implants have made them quite sick in recent years. Symptoms of autoimmune disorders, such as weariness, muscle and joint aches, fevers, dry eyes and mouth, and occasionally poor memory or concentration, continue to be reported by breast implant recipients.
Unfortunately, most women who want their breast implants removed for medical reasons will be denied coverage by their health insurance. Breast “explant” surgery is not covered by health plans because it is “not medically required” or is restricted by plan restrictions. Dealing with your insurance carrier to get therapy covered can be frustrating and time-consuming. When dealing with insurance providers, knowledge is power. Here are some pointers to help you get the most out of your insurance for breast explant surgery.
How painful is breast explant surgery?
Before you leave the hospital, a nurse or other healthcare worker will give you discharge and self-care instructions. This will provide information on the following topics:
Although the recovery time for breast implant removal varies, it usually takes several weeks.
It’s typical to experience some pain, discomfort, and edema following surgery. It will also be difficult to move your arms and upper body as freely as usual. Within a few weeks, you should have better movement and less pain.
During the recuperation time, it’s critical to rest and follow your surgeon’s recommendations to avoid complications.
What happens if you don’t replace breast implants?
Dr. Steven Yarinsky, a board-certified plastic surgeon, explains that while breast implants can last a long time, they should not be considered lifetime medical devices. Saline implants may deflate if they burst or leak. Capsular contracture, which is the shrinkage of natural scar tissue produced by your body around any implanted medical device, may also develop. This can cause firm or rigid breasts, as well as a visible or palpable malformation. Because the implants are not meant to last a lifetime, they will most likely need to be replaced after 10 to 15 years. Having stated that, if implants are necessary, “If they’re “up and running” and aren’t causing any issues, there’s no need to replace them. Many of our patients have had their implants for over 20 years and have had no complications.
If hard breasts or capsular contracture develops, the thick scar capsule can be removed with or without the implants being replaced. When saline implants rupture, the salt water filling is resorbed, resulting in an infection “the appearance of a flat tire Leaving deflated saline implants in place can lead to further capsular or scar tissue contracture, as well as visible breast deformity. As a result, saline implants should be replaced within a month or two of deflation. If silicone gel-filled implants (also called as saline implants) are used, “No change in breast shape or size is visible when gummy bears”) break, but the affected breast may feel softer. A breast ultrasound or MRI should be performed every 5 to 7 years after silicone gel implant insertion to rule out a problem “There was a silent rupture.” If a silicone gel implant’s shell breaks, silicone oil can leak out. While there is no scientific evidence that loose silicone gel causes harm to the body, the FDA has developed and approved the implants to be used with an intact shell surrounding the gel fill material. Though there may be no difference in the appearance of the breasts, it is recommended that broken gel implants be replaced or, if requested, removed without replacement, out of an abundance of caution and with patient safety in mind.
When patients consider having their implants removed, whether due to a mechanical issue such implant shell breaking, capsular contracture, or personal preference, the topic of whether they should replace their implants or return to their natural breast size arises frequently.
Breast augmentation with implants extends the overlying breast skin envelope, resulting in an increase in breast skin volume. When breast implants are removed without being replaced, there is often a volume and skin mismatch, resulting in breast droopiness or asymmetry “ptosis” is an abbreviation for “ptosis.” As a result, persons considering breast implant removal without replacement should be aware that their breasts may not resemble the same as they did prior to augmentation. The age of a woman, the size of her implants, and the amount of time she has had them can all produce alterations that may not be visible until the implants are removed. For example, the weight of a bigger implant combined with gravity effects over time can cause the skin and breast ligaments to strain, resulting in sagging tissue.
To address the loose skin breast ptosis that follows from removing implants without replacement, Dr. Yarinsky frequently advises a breast lift to remove excess loose skin and tighten the ligaments. This helps to provide a more young and shapely breast appearance while preventing a droopy appearance “deflated” appearance Women with good breast skin elasticity and smaller implants may discover that their breasts recover to the same size and shape they had before breast augmentation after implant removal.
A personalized consultation with a board-certified plastic surgeon is the best approach to learn how your breasts will look following breast implant removal without replacement. Dr. Yarinsky helps patients by modelling and previewing their expected results using Crisalix 3D and 4D imaging technology.
How much does it cost to have the nexplanon removed?
The cost of a birth control implant, commonly known as Nexplanon, can range from $0 to $1,300. The cost of implant removal varies from $0 to $300. The good news is that most health insurance plans, Medicaid, and certain other government programs cover implants for free (or at a modest cost).
Even while the implant is more expensive up front than other options, it saves you money in the long run because it lasts for 5 years.
If cost is a concern, contact your local Planned Parenthood health center to see if they can assist you in finding birth control that suits your budget.
Planned Parenthood can also assist you in obtaining health insurance, as most insurance plans are required to include birth control at no cost to you under the Affordable Care Act (commonly known as Obamacare). Learn more about birth control and health insurance.
Should I get an explant?
The surgery to remove breast implants is known as breast implant removal. A surgeon may also remove scar tissue or silicone from implant leaks during the procedure.
Your surgeon may recommend that you have your old implants removed and replaced with new ones. Or you can decide you don’t want implants at all. People may require surgery if they have experienced implant difficulties.
Why is breast implant removal done?
Breast implants are only good for a few years. Breast implants should be removed or replaced every 10 to 15 years, according to the American Society of Plastic Surgeons. If you haven’t had any issues, your plastic surgeon may not recommend that you get them removed.
Because the contour of their breasts has changed since their breast augmentation, some women want to have their breast implants removed. The appearance of your breasts may alter as a result of:
Who needs to have breast implant removal?
Breast implant removal or replacement may be medically required in some instances. Scar tissue forms around the implants, which is the most common reason for implant removal. Capsular contracture is the term for this stiffening. It can result in pain, discomfort, or the appearance of breasts that aren’t what they used to be.
- BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) is a rare malignancy that develops in the scar tissue surrounding a breast implant. Textured implants are linked to BIA-ALCL. If you’ve ever received textured implants, you should check with your plastic surgeon.
Will insurance cover capsular contracture?
Insurance companies typically consider breast augmentation to be an elective cosmetic surgical treatment, and it may or may not be covered under health coverage. However, health concerns associated with breast implants, such as capsular contracture, are frequently classified as medical rather than cosmetic.
The patient should contact her insurance provider to learn more about her unique insurance policy’s coverage for breast capsulectomy. Dr. Hisham Seify, a board-certified plastic surgeon, performs breast implants and other treatments for patients in Newport Beach, Orange County, and the surrounding areas.
Insurance Eligibility
Patients should be aware that in order for a breast implant plastic surgery complication to be covered by insurance, it must be more than just an aesthetic concern, such as asymmetry, implant rippling, or an undesirable implant size or form. If left untreated, the breast implant problem must constitute a direct threat to the patient’s health. The breast capsulectomy operation may be covered by insurance only if certain conditions are met.
If the capsular contracture is severe, it will be classified as a major breast implant problem with serious health consequences if left untreated. As a result, receiving insurance coverage for breast capsulectomy surgery may be achievable. Dr. Seify is a top cosmetic surgeon in Newport Beach, Orange County, California, who performs breast capsulectomy and other treatments on patients.
Proper Documentation
While there is no assurance when it comes to gaining insurance coverage for breast capsulectomy surgery, appropriate paperwork can help to boost the odds of coverage. Spending the time and effort to organize proper papers that detail the exact nature of the illness from the moment the first symptoms appeared is worthwhile.
The patient must work with the plastic surgeon’s office to arrange for accurate and adequate medical documentation that defines the problem and outlines the risks to the patient’s health if it is not treated.
Degree of Capsular Contracture
It is critical to define the degree of capsular contracture in the documentation in order to secure insurance coverage. The Baker Scale is one of the most common methods used by insurance companies to decide whether or not a woman is eligible for a breast capsulectomy. If the capsular contracture is classified as Grade 1 or 2, the insurance company is unlikely to consider it severe enough to merit coverage.
Grade 3 or Grade 4 capsular contracture, on the other hand, might produce pain, visual deformity, and potentially obstruct clear mammography results. In such circumstances, insurance companies would frequently cover breast capsulectomy surgery to alleviate the problem.
Payment for Specific Procedures
Even if an insurance company agrees to cover breast capsulectomy, they may only cover the portion of the procedure that involves implant removal and scar tissue removal. They normally won’t pay for the replacement of old breast implants with new ones, or for the replacement of the original implants, because it won’t have a direct influence on the patient’s health. Even if it improves their psychology, self-confidence, and, possibly, money!
Dr. Hisham Seify, a plastic surgeon in Newport Beach, offers a variety of operations and treatments.
Will insurance cover MRI for breast implants?
Imaging testing for breast implant ruptures are frequently not covered by health insurance. While your plastic surgeon may be able to work with your insurance provider to obtain coverage, some expenditures, such as your deductible, may be your responsibility.
You are not required to use a hospital for imaging services. AHI, a stand-alone clinic, provides the same imaging screenings and advanced diagnostic technologies as a hospital, but our imaging services are often much less expensive. At AHI, an expedited breast MRI costs only $450. (with or without physician referral).
In Decatur, Lawrenceville, and Sandy Springs, AHI offers expedited breast MRI. Make an appointment right now.
How do breasts look after explant surgery?
When the implants are removed, most patients should not expect their breasts to revert to their pre-augmentation state. This is due to the fact that implant placement stretches the skin, and the weight of the implants causes some sagging. Variations in the shape, size, and position of the breasts after explant surgery can be caused by a variety of causes. Breast volume may be slightly higher than before implants were inserted if the patient has acquired significant weight following the initial breast augmentation operation. Aging, pregnancies, and genetic factors can all impact the quality of remaining breast tissue as well as skin flexibility, putting the breasts’ appearance at risk.
Working with a board-certified breast explant surgeon can help you get a beautiful, natural-looking result. Drs. David Rankin and Dev Vibhakar will evaluate your specific needs, such as the quality of your breast tissue, skin elasticity, and personal preferences, while arranging your explant surgery.