For the most part, opens in a new windowbreast augmentation is an elective cosmetic enhancement, which puts the procedures outside the realm of standard health insurance coverage. However, there are a few circumstances that could warrant coverage of breast implants under certain conditions.
1. Significant Asymmetry
While women commonly think of breast implants simply as a solution for increasing their cup size, I help many of my patients resolve concerns with asymmetry with implants as well. No woman’s breasts are perfectly symmetrical, but a difference of a cup size or more can be very frustrating. Some insurance companies may cover breast augmentation in cases of severe asymmetry due to congenital abnormalities, although this is determined on a case-by-case basis and coverage is infrequent.
2. Reconstructive Surgery
Federal law dictates that any insurance companies that pay for breast cancer treatments like lumpectomies and mastectomies must also cover the necessary costs related to reconstructive surgery. Although specific opens in a new windowreconstruction laws vary by state, breast implants should be covered for reconstructive purposes in nearly every case. This often includes reconstruction after injuries, trauma or due to congenital defects that are not related to breast cancer.
3. Contralateral Procedures
The same insurance regulations that require coverage of reconstructive procedures extend to any surgeries or treatments necessary on the opposite breast to ensure symmetry. For example, if the reconstructed breast will end up larger than the natural breast, insurance would cover a breast implant for the contralateral (non-reconstructed) breast as well.
The key word to remember in all of this is “may”—as in, your insurance may cover these options. While most policies do cover breast cancer treatment and reconstruction, it’s best to check directly with your policy provider.
Dr. Nirav Savalia is a board-certified plastic surgeon in Orange County with offices in Newport Beach and Fullerton. Known for his skill, compassion and dedication to patient-centered care, Dr. Savalia works closely with each patient to develop an individualized plan to achieve their cosmetic goals. He is board certified by both the American Board of Surgery and the American Board of Plastic Surgery.