Does Insurance Cover Breast Removal?

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.

Does insurance pay for removal of breast implants?

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 leaky 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 big do your breasts need to be to get a reduction?

According to Dr. Bernard, the surgery is an outpatient procedure that takes roughly three hours. Women usually return home the same day or the following morning. However, you’ll most certainly be exhausted and hurting afterward, so take a few days off work or school to recover. You’ll be encouraged to get up and move around on a daily basis, but any strenuous exercise should be avoided for about a month, he advises.

You might not be able to get the exact cup size you want

The extent to which your breasts can be lowered is determined by your size, breast composition, and desired results. Your plastic surgeons will assist you in determining the best course of action throughout your consultation. According to Dr. Bernard, most breast reduction patients lose one to two cup sizes.

You’ll get a breast lift, too

Your surgeon will remove superfluous tissue and skin from your breasts to make them smaller, and then relocate your nipples up in place to give them a lift.

You’ll have scars

For a period, the incision wounds (which commonly resemble lollipops and loop around the nipples before going straight down to the bottom of the breast) will swell. “Scars improve dramatically in most people within a year of surgery, but they’re always there,” Dr. Bernard explains.

“It’s just as much genetics as anything else when it comes to scars. Every plastic surgeon can close a wound well, but it all relies on the individual.”

There’s a chance you’ll have decreased nipple sensation

Your nipples may feel numb immediately after surgery. “Almost invariably, some sensation in the nipples returns, although it may take a month or two,” Dr. Bernard explains. Certain surgical approaches are more likely to retain nipple sensation, so if this is a concern for you, make sure to discuss it with your surgeon.

How can I remove my breast?

A mastectomy is normally done under general anesthesia, which means you won’t feel anything during the procedure. An oval incision around your breast is made first by your surgeon. The breast tissue is removed, and other sections of the breast may be removed as well, depending on your operation.

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.

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.

Do breasts bounce back after implant removal?

Breasts following the removal of the implants This occurs as a result of breast weight, which causes straining of the breast tissue and rib cage alterations. Breast tissue can be tightened and altered, but it will not spontaneously return to its previous state, which is why breast implant explant revision is occasionally required.

Will I feel better after breast implant removal?

I understand if you’re considering explantation because you’re concerned about or suspect you have “breast implant sickness.” Patients who have had their implants removed report that symptoms like weariness, migraines, and joint discomfort have eased or that they feel better overall. Even if explantation patients do not see a change in their symptoms, they may be relieved to have gotten rid of something that had been bothering them.

It’s crucial to understand that we can’t guarantee that removing your implants would help your health because there aren’t any scientific studies confirming that breast implants might create systemic difficulties. To rule out any diagnosable causes for symptoms, such as Lyme disease, make sure you’ve seen your primary care physician first. If you can’t discover an answer, you might want to try removing your implants, however explantation may or may not help.

In my clinic, I am pleased to conduct explantation if a patient wants her implants removed and is a good candidate for surgery (i.e., her health allows her to undertake the treatment and she is well-informed). As with any cosmetic operation, I will strive to get the most aesthetically attractive result possible.

How much do DD cup breast weigh?

For both of your breasts, DD cups can weigh up to 4.2 pounds. Each of your breasts may weigh around 950 ml or 2.09 pounds if your bra size is a DD cup. Your bra size can also help you estimate how much they weigh.

What are the symptoms of needing a breast reduction?

According to the American Society of Cosmetic Surgeons, breast augmentation is the most popular surgical operation, but breast reduction, another plastic surgery procedure that modifies the breasts, can have equally life-changing benefits for those who require it. Although it may appear that everyone is wanting to grow their breasts bigger, women with huge breasts frequently suffer from physical and emotional anguish as a result of their breasts. Women with enormous breasts, especially those that droop and hang, suffer from physical and emotional problems such as neck, shoulder, and back pain, low self-esteem, and a lifetime of suffering. People without large breasts may find it difficult to understand that having a huge breast may affect your daily life, yet ladies with large breasts will tell you about their difficulties exercising, sleeping, and more. Breast reduction surgery allows women with enormous breasts to eliminate the pain and inconvenient aspects of their figures, but many women are unaware of the signs that suggest the necessity for surgery.

What are the symptoms of needing a breast reduction?

Breast reductions are done for a variety of reasons, including physical and emotional discomfort. Breast reduction surgery may be beneficial if you are experiencing any of the following symptoms as a result of your large breasts:

Several of these symptoms are common in women with big breasts. Some health insurance companies may cover the cost of breast reduction surgery depending on the severity of the problems.

What are the benefits of breast reduction surgery?

The weight of a patient’s enormous breasts can be both actual and symbolic. Daily tasks such as exercise, sitting straight, and sleeping can be difficult or impossible. Breast reduction surgery relieves a lot of the physical pain that comes with having large breasts, such as back, neck, and shoulder pain, as well as discomfort while exercising and shoulder grooves. Many women report feeling more confident about their bodies and wearing specific ensembles in public as a result of breast reduction surgery, and this boost in confidence is a significant emotional benefit. Breast reduction surgery also has a number of cosmetic advantages, including:

Finding stylish and comfy bras, swimwear, sports bras, and clothes is simple.

Who is a good candidate for a breast reduction?

Women who suffer from the physical pain or emotional symptoms linked with large breasts and desire to alleviate these concerns are the greatest candidates for breast reduction. Breast reduction surgery can be done at any age, but teenagers who undergo it before their breasts have fully matured may require a second procedure later. Breast reduction surgery should be postponed for women who are expecting to have children until after their last pregnancy, as breasts grow and shrink during pregnancy, and breast reduction may affect a woman’s ability to nurse. Breast reduction surgery should be postponed for women who plan to lose a large amount of weight, as weight loss can alter the size and contour of the breasts. Breast reduction surgery should be avoided by patients who smoke, have specific medical conditions such as diabetes or heart disease, are extremely obese, or do not want scars on their breasts.