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 is capsular contracture surgery?
A capsular contracture operation might cost anywhere between $1,500 and $12,000, depending on the quantity of treatment required to get your desired outcomes. We recommend that you come in for a consultation with one of our board-certified plastic surgeons if you have developed a capsular contracture. During this time, we will create a specific treatment plan for you, which will include the total cost of your therapy. To keep this procedure inexpensive and accessible, the Plastic & Cosmetic Surgery Center of Texas offers flexible payment alternatives and accepts all major credit cards.
Does insurance cover breast encapsulation?
If the implants are put for cosmetic reasons, the insurance company will normally only pay for the removal and/or capsulectomy of the implants, as well as for ruptured implants or uncomfortable capsular contracture. This does not involve implant replacement or dealing with the loose skin and sagging breast tissue that can result from removing an implant without replacing it.
The problem with having your insurance carrier cover implant removal is that they frequently deny payment after the surgery is completed, leaving the patient responsible for the surgeon’s fee, anesthesia fee, and O.R. fee, all of which are significantly higher than the fee charged if the procedure had been performed as a cosmetic procedure.
Also, to avoid any misunderstanding, we normally don’t charge for implant removal if a capsulectomy or mastopexy (breast lift) is performed concurrently as a cosmetic treatment. Any inquiries you may have will be gladly answered by our office.
How long can you live with capsular contracture?
Other than your discomfort, leaving a breast capsular contracture alone has no long-term consequences. Tightness and the sensation of something hard on the chest, especially when lying on it, are the symptoms. There can be a lot of discomfort at times. In the absence of this, many women have lived with a contracture for 20-30 years. The contracture may reoccur if you have your breast augmentation redone. To avoid this, you should have the implant redone with a different type of implant (textured vs smooth), in a different pocket, with an acellular dermal matrix, or a combination of these options. Consult a plastic surgeon with extensive experience in revision treatments to learn more about your alternatives.
Can capsular contracture be fixed without surgery?
Yes, the Aspen Ultrasound System is a non-invasive procedure that combines deep sound wave therapy (ultrasound) with focused massage to help break up extra scar tissue and release the capsule in a painless manner. This procedure can help patients with mild to severe capsular contracture ease pain and hardness while also allowing the breast implant to assume a more natural position without having to go through the expense, recovery time, and hazards of a second operation.
In our experience, roughly 80% of our patients perceive a difference after treatment with the Aspen Ultrasound System. We will usually offer this non-invasive treatment initially to people who are judged good candidates.
How much does it cost to replace one breast implant?
The cost of one breast depends on the work that needs to be done. It might be as low as $2500 or as much as $5 or $6 thousand.
How long does capsular contracture surgery take?
Capsular Contraction Correction is an outpatient procedure that takes between two and six hours to complete. A tiny inframammary or periareolar incision will be made first. He will then either release the scar tissue or remove the implant/tissue, depending on the surgical procedure employed. A replacement implant may be placed at this time. Finally, dissolvable sutures will be used to close the incision.
Will insurance cover replacing breast implants?
Breast augmentation surgery, which involves the placement of breast implants for cosmetic reasons, will cost an average of $4,516 in the United States in 2020.
The majority of women are responsible for paying this out of their own pockets. Breast augmentation surgery is frequently not covered by insurance. Breast implants will, however, be covered for women who have had mastectomies owing to breast cancer.
If you require additional surgery in the future, your health insurance may not pay it. Breast implants may effect your insurance rates in the future.
How much do breast implants cost 2020?
So, what does it cost to get breast implants? As recently as 2020, the average cost of breast implant surgery will be between $6,000 and $12,000. While this price may appear to be a good investment, it’s worth noting that the cost of breast implants has remained quite constant over the last few decades. Breast implants are also often thought to be a long-term investment because of how long the results last.
A breast lift, for example, might cost anything from $9,000 to $16,000. The relative intricacy of a breast lift is one reason why it can be more expensive than breast implants. Breast lift surgery is often more expensive than breast implants because it requires more time and skill from the surgeon to remove tissue and lift the breasts into a higher position. The disadvantage of this higher price is that the results of a breast lift do not endure as long as those of breast implants.
What Determines Breast Implants Cost?
Naturally, the average price range for breast implants pertains mostly to the cost of the procedure. Varied types of implants have different price tags, which is typical. The size of the implant, in particular, may play a significant role in the final cost of breast implant surgery. Another aspect that may influence the price of breast implants is the operation procedure, such as whether the implant is placed under or on top of the pectoral muscle; the more involved the surgery, the higher the price.
Is it safe to live with capsular contracture?
Clinicians have a variety of views about what causes capsular contracture, and the specific causes are likely to vary from patient to patient. It’s critical to understand as a breast augmentation patient that this issue is not caused by breast implants being toxic or hazardous in any way. Silicone gel implants are constructed of medically inert silicone, while saline implants contain simply saline solution, which can be safely reabsorbed by the body with no harmful consequences. Capsular contracture can occur after any type of medical implant is placed in the body; it is not limited to breast augmentation surgery. Capsular contracture is especially concerning following breast augmentation since it frequently changes the appearance of the breasts, risking the aesthetic benefits that the patient sought through surgery. Unless the patient’s implants have ruptured, capsular contracture is usually not harmful to her health (in the case of gel implants, rupture can sometimes lead to infection).
Genetics, according to researchers, plays a part in determining who suffers capsular contraction and who does not. You may be at a slightly higher risk of having this illness if you have a family history of autoimmune disease or relatives who commonly develop thick scar tissue following injury (or who have had problems with medical implants). It’s hard to know who will develop a “random” case of capsular contracture (one that isn’t induced by any external causes) and who won’t. You shouldn’t let your worry of having capsular contracture keep you from obtaining breast augmentation surgery because it’s highly treatable.
Capsular contracture can be induced by a variety of factors other than the patient’s own body reacting negatively to the presence of breast implants. In addition to implant ruptures, it is now thought that a condition known as “biofilm” is a common cause of this ailment. Biofilm is a thin layer of bacteria that forms around implants after germs (mostly staph bacteria) are injected into the breast cavity during surgery. This bacterium causes a low-grade, persistent infection that may or may not cause symptoms (such as fever or severe fatigue). However, as the body fights the infection, it creates more fibrous scar tissue, which leads to capsular contracture. A recent study conducted on pigs implanted with medical-grade silicone implants backed up the biofilm theory of capsular contracture. This study discovered that pigs with staph bacteria on their skin at the time of implant insertion had a significantly higher risk of capsular contracture. It’s crucial to remember that staph contamination during breast augmentation surgery isn’t always caused by an unsanitary working environment. Staph bacterium is carried naturally by some people; it is always present on their skin and normally causes no symptoms. This bacterium has a potential to create major problems only when the skin of these people is penetrated. While maintaining a clean working environment can assist to reduce the danger of staph contamination, it’s not always possible to eradicate all of the bacteria present.
Other uncommon breast augmentation problems, such as hematomas and seromas (blood clots that can occur following invasive surgery), are thought to increase the chance of capsular contracture. Some studies believe that blood clots enhance the risk of capsular contracture by providing bacteria with a plentiful supply of nutrients (in the form of blood), allowing biofilm to proliferate. What can be done to avoid capsular contracture?
While capsular contracture cannot be prevented in every patient, there are numerous techniques to reduce a patient’s risk of developing the condition. As a result, plastic surgeons now use a variety of prophylactic techniques, as indicated below:
- Patients are thoroughly checked for health issues that could increase their risk of complications such as hematomas. Patients must also stop smoking, as it increases the risk of hematoma formation and slows the healing process in general.
- Choosing the right implant size for the patient: Using a big implant in a patient who lacks enough natural breast tissue to cover it increases the risk of capsular contracture. If a patient with small breasts wishes to drastically enhance her cup size, it’s best to do it in stages, such as starting with a mid-sized implant and allowing the skin to stretch before moving on to a larger one.
- Minimal implant handling: The more an implant is handled before it is implanted into a patient’s breast, the more probable it is to become bacterially contaminated. As a result, before placing an implant in a patient’s body, doctors rigorously limit how much they contact it. Plastic surgeons that are board-certified also practice in a sterile hospital setting.
- The use of textured gel implants has been demonstrated to lower the likelihood of capsular contraction when compared to smooth gel implants. It’s considered that the implant’s rough surface makes it more difficult for thick scar tissue to form around it. However, textured implants are not suitable for every patient, as their edges may be more visible in some circumstances. When the implants are put below the chest muscles, they are usually the best option.
- Implant placement “under the muscle”: Implant placement “under the muscle” can considerably reduce the risk of capsular contracture. Under the muscle implant location has an 8-12 percent lifetime risk of capsular contracture, whereas above the muscle implant placement has a 12-18 percent lifetime risk of capsular contracture. Furthermore, implants that are entirely under the muscle have a lifetime risk of capsular contracture of only 4-8 percent.
- Massage: Massaging the breasts gently while they recuperate from breast augmentation surgery can help prevent capsular contracture by keeping the breast tissue supple. However, no substantial research have demonstrated that this strategy is beneficial. You should never disrupt the tissue of your breasts while they are recovering after surgery unless your surgeon has given you permission. Otherwise, you risk damaging the tissue and increasing the risk of capsular contracture.