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.
Does insurance cover breast implant removal?
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 much does it cost for breast explant?
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 provider may or may not cover your breast implants if you acquired them for enhancement 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.
How much does it cost to remove and replace breast implants?
According to the American Society of Plastic Surgeons, the average cost of breast implant removal surgery is $2,641.
The total cost of the surgery, including the surgeon’s fee, is shown here. Additional costs, such as anesthesia and facility fees, are not included.
Keep in mind that you may incur additional post-surgery expenses, such as recovery drugs and post-surgery undergarments.
While most medical insurance policies do not cover the cost of breast augmentation surgery, your insurer may cover the cost of implant removal in certain instances.
This could be the situation if your doctor determines that implant removal is medically necessary because the implants are posing a health risk.
If you meet the following conditions, your insurance company may cover all or part of the cost of breast implant removal surgery:
Your insurance company most likely has a policy that dictates how much it will pay for breast implant removal surgery.
However, if you only want the surgery for cosmetic reasons, insurance is unlikely to cover the cost.
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.
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.
How long does breast explant surgery take?
If you’re thinking about getting your breast implants removed, you certainly have a lot of questions and concerns about it. Dr. Ortiz, a board-certified plastic surgeon in Raleigh, is answering your commonly asked questions to help you better understand what’s involved.
What is a breast implant removal?
If you have breast implants from a breast augmentation or reconstruction treatment and would like them removed, we can do it. Breast implants aren’t meant to last forever, and they may need to be replaced or removed as early as 10 to 15 years. Women who have undergone physical changes over the years frequently discover that their implants no longer fit their bodies and are ready to have them removed or replaced. An implant that has leaked or developed painful scar tissue may also need to be removed in rare situations.
What happens at my initial consultation?
Dr. Ortiz will sit down with you and go over everything you need to know about the operation. This includes not just the type of surgery, but also the cost and what you may expect in terms of aesthetics and recovery.
How is the procedure performed?
An incision will be made either along the inframammary fold under the breast or around or below the areola after you have been given anesthetic. Dr.Ortiz may use that place to avoid developing an extra scar based on the scar from your breast augmentation operation. The breast “capsule,” which is the fibrous scar tissue that grows around an implant, is also removed. A breast lift may be performed during this stage of the procedure if it is recommended. The incision will then be closed by Dr.Ortiz, and you will be able to rest and recover in a private area.
How long does it take to remove the implants?
Depending on whether there was leaking, a rupture, or extra scar tissue, the treatment normally takes one to three hours. As the anaesthetic wears off, you’ll have a few hours of recuperation time after the procedure.
What kind of scars will I have?
To avoid noticeable scarring, the incisions are made in inconspicuous spots, and Dr. Ortiz can often reuse the same incision from the breast augmentation treatment to avoid having to add another scar. If a new incision is made, it will be under the breast along the inframammary fold or around the areola, where the scar will be less visible due to changes in skin colour.
What can I expect from the results, appearance-wise?
Your final outcomes will be determined by a number of factors, including the original size of your implants, the amount of breast tissue remaining, and the presence of scar tissue. Because the surgery can cause swelling, you may not see the final results for several weeks or perhaps a year after your procedure.
During your initial consultation, Dr. Ortiz will sit down with you and offer you a more realistic idea of how you’ll look without the implants.
What is the recovery process like?
You’ll need someone to drive you home from the center and stay with you for 24 hours after the procedure because you’ll be coming out of anesthesia. Following the surgery, you will be on narcotic pain medicine for about two days, and NSAIDs (like Advil or Aleve) are prescribed for any pain beyond that. Once you’ve stopped using drugs, you’ll be able to drive again, and most patients can return to work in two or three days. We’ll provide you compression garments to wear for six weeks, and it’s crucial to avoid excessive activities and exercise during that period (besides walking). It’s crucial to sleep on your back or side when recovering.
How much does breast implant removal cost?
This is dependent on a number of things. The type of previous augmentation, the severity of the scar tissue, and whether or if there are any additional surgeries such as a breast lift.
What are your payment terms?
To reserve your surgery date, we require a deposit of 25% of the total cost up front. The remaining sum must be paid in full at least two weeks prior to the operation date. We take Care Credit, Alpheon, and all major credit cards, even though most cosmetic operations are not covered by insurance.
Are there complications with a breast implant removal procedure?
Breast implant removal is a relatively safe operation with a low risk of complications. Infection, discomfort, hematoma, and unattractive scars are the most common consequences. During your consultation, Dr. Ortiz will go over any potential issues and address any concerns you may have.
How much does an explant with Lift cost?
The Price. Unless you’re having your breast implants removed due to a medical condition, you’ll have to pay for it yourself. Depending on the surgeon you choose, the operation might cost anywhere from $1,000 to $4,000. If the expense is something you can’t think about right now, you’ll want to postpone the removal.
How much of the breast is removed in a mastectomy?
The entire breast, including the breast tissue, areola, and nipple, is removed during a total mastectomy, also known as a straightforward mastectomy. During a complete mastectomy, a sentinel lymph node biopsy may be performed.
Can a general surgeon remove breast implants?
Plastic surgeons (who are used to dealing with breast implants on a regular basis) are the best candidates for breast implant removal. A general surgeon, on the other hand, may easily remove a breast implant if a plastic surgeon is unavailable.