In Alberta, breast lift surgery is considered a cosmetic procedure. However, if you suffer from ptosis (drooping breasts), which can be caused by aging or pregnancy, the government may cover the cost of your surgery.
You may be eligible for a partial reimbursement if you have a breast lift performed that includes other procedures such as augmentation (breast enlargement) or reduction (breast reduction).
If you meet the criteria for partial coverage, any costs not covered by Alberta Health should be paid in full by yourself or your private health care provider.
This post also talk about what is not covered by alberta health care and breast reduction weight requirements canada.
What is breast reduction surgery?
Breast reduction surgery is a functional surgery meant to decrease the size, weight, and volume of the breasts.
The purpose of a breast reduction is to address functional issues such as neck, back, and shoulder pain that may be secondary to large breasts. A breast reduction may also address some cosmetic concerns, however the primary goal is a reduction in breast size.
Who should get a breast reduction?
Breast reduction surgery can improve quality of life for patients who have issues with back, neck, and shoulder pain secondary to large, heavy breasts.
The surgery may also improve the ability to participate in physical activity such as sports, exercise, or running. Prior to surgery, patients should be at their goal weight with a healthy body mass index. Significant weight loss after a breast reduction can negatively impact the surgical results.
How much does breast reduction surgery cost?
If the surgery is considered a functional breast reduction, it can be covered by Alberta Health Services (at the time of this writing).
In order to do surgery through AHS, we require a referral from your family practitioner. Due to the excessive volume of AHS referrals, we can’t always take referrals, and it may take up to two years from time of referral to time of surgery. If the goal is a breast lift without any reduction in breast size, or a reduction smaller than 300 grams, the cost to do a cosmetic breast lift is $9,500.
Can a breast reduction be covered by insurance?
Breast reduction surgery can be covered by health insurance in Alberta. To qualify, at least 300 grams of tissue needs to be removed. This roughly equates to 2 bra-cup sizes (i.e. from a D cup down to a B).
If the primary goal is a breast lift, the procedure will not be covered by health insurance.
How old do I have to be to get a breast reduction?
There is no specific age cut-off for breast reduction surgery. Some teens may benefit prior to the age of 18. The breasts should be fully developed, and stable in size/volume prior to a breast reduction. In some patients, this occurs before the age of 18.
Breast reduction surgery can affect the ability to breast feed in the future, and this can be an important consideration in patients considering having children in the future.
What Is Not Covered By Alberta Health Care
Alberta Health Care Insurance Plan (AHCIP) does not cover eyeglasses and contact lenses, refractive laser eye surgery, vision care such as routine eye exams for residents 19 to 64 years of age.
How long does it take to recover from the surgery? When will I be able to exercise/lift things?
Everyone is different in terms of the recovery process. The worst pain and swelling occurs in the first few days after surgery. Most patients are resuming gentle exercise and lifting by 3 weeks after surgery. Resuming more aggressive activity and sports can take up to 8 weeks after surgery.
Final surgical results in terms of breast contour, and scar maturity can take up to 12 months.
How much pain should I expect during/after the procedure?
Some pain after surgery is normal, and helps to protect the body from injury. The pain should be tolerable with over the counter or prescribed pain medications.
Most patients experience discomfort, but are still able to sleep and perform normal activities of daily living within a few days of surgery.
Can I be awake during the surgery?
Breast reduction surgery is generally performed with general anesthetic.
Will I have scars? Is there any way to avoid them?
A breast reduction will create scars on the breast.
There is almost always a scar around the areola and down the front of the breast. Sometimes a scar is added in the fold underneath the breast. The specific location and pattern of the scar depends on the breast size and goals of surgery.
Scars will be discussed in the pre-operative consultation.
How long does the surgery take?
The actual surgery takes roughly 2 hours to complete
How should I prepare for the surgery?
To prepare for surgery, you should be at your ideal goal weight. If you are planning on losing weight, it should be done prior to surgery, and your weight should be stable prior to surgery.
Any medical issues such as high blood pressure or diabetes should be well managed before proceeding with surgery. Nicotine use in any form raises the chance of having post-operative complications. Nicotine should be avoided for at least 3 weeks prior to surgery.
The breast reduction surgery process
We start by marking out the breast reduction pattern with the patient awake prior to surgery. Once the marking is complete, the patient is taken to the operating room.
The surgery is performed and the required amount of tissue is removed from the breasts. Care is taken to correct any pre-existing asymmetries between the two breasts.
The surgical incisions are closed with an absorbable stitch. After surgery, the breasts are dressed with surgical tapes, gauze, and either a bra or breast binder.
The patient is awoken and taken to the recovery room. Patients generally spend about an hour in the recovery room. They are discharged home once they are able to drink fluids, walk, and their pain is adequately controlled.
What are the risks and potential complications?
With any surgery, there is a small risk of infection, bleeding, and risks related to the anesthetic.
The most common potential complications after surgery are wound healing issues, or having small openings in the incision. We usually let these heal on their own.
There are potential cosmetic issues after surgery such as contour deformities, nipple position, or unfavourable scarring.
Breast surgery may make it impossible to breast feed after surgery. Risks will be discussed in more detail during the consultation process.
Breast Reduction Weight Requirements Canada
To qualify, at least 300 grams of tissue needs to be removed. This roughly equates to 2 bra-cup sizes (i.e. from a D cup down to a B).
If the primary goal is a breast lift, the procedure will not be covered by health insurance.
Does Insurance Cover Breast Lifts?
In general, each specific insurance company determines what procedures they will or will not cover. The biggest factor insurance companies consider is whether the procedure is reconstructive or cosmetic in nature. The American Medical Association (AMA) defines these as follows:
- Reconstructive surgery refers to procedures performed to correct trauma, developmental defects, infection or disease. Reconstructive procedures focus on improving function or normalizing appearance of the patient.
- Cosmetic surgery refers to procedures that are focused on improving the aesthetic appearance of the face or body to improve a patient’s appearance or self-esteem.
Many insurance companies, however, can interpret the above definitions differently depending on the specific procedure and situation. Due to these variances it is very important to contact your insurance provider and discuss how your procedure will be classified. While plastic surgeons (and their billing representatives) can counsel you on the potential for insurance coverage it’s always best to go to the source.
In general, breast lift surgery is considered cosmetic in nature and is not likely to be covered by medical insurance. For such a procedure to be approved, medical necessity would have to be demonstrated. There are some circumstances where back/neck/shoulder problems can be traced to very enlarged breasts and a case of medical necessity for breast reduction surgery has successfully been made. But if you are just losing the battle with time and gravity, you should not expect a breast lift to be covered by your health insurance.
If you are interested in breast lift surgery in Gainesville, contact Dr. David W. Allison at 703-754-8228 or mdallison.com to schedule a consultation. Dr. Allison will evaluate your specific areas of concern and let you know if your desired surgery may be deemed medically necessary and possibly covered by your insurance.