Cosmetic Surgery Tips

can breast augmentation be covered by insurance

Can Breast Augmentation be Covered by Insurance?

Breast augmentation is a popular procedure that can increase the size of your breasts, giving them a more natural appearance. It’s also a surgery that many women want and need, but are unable to afford. However, it is possible to get breast augmentation covered by insurance.

How Does Breast Augmentation Work?

During breast augmentation, silicone or saline implants are placed in the breast to create the desired size and shape. The implants are placed through an incision in your armpit or around the nipple area. The implant then sits behind your muscle tissue and fat layer, where it will stay permanently.

What is Cosmetic Surgery?

Cosmetic surgery is surgery performed for aesthetic reasons rather than medical ones—for example, to improve one’s appearance or self-esteem. Cosmetic surgeries include procedures like liposuction and breast augmentation—both of which can be covered by insurance if deemed medically necessary by your doctor.

can breast augmentation be covered by insurance

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If you have decided to have breast augmentation surgery, there are several things to consider, such as which type of breast implant and size will work best for you, plus finding the right plastic surgeon in your area. Another important element is finding out whether your insurance will cover your breast augmentation procedure. It’s essential to have a clear understanding of the costs involved before having any plastic surgery. Typically, breast augmentation is considered elective surgery and is not covered by insurance. However, breast reconstruction surgery that involves breast implants may be fully or partially covered. It is wise to educate yourself about the details of your plastic surgery and insurance coverage before scheduling your procedure.

Dual board-certified aesthetic plastic surgeon Dr. Nana Mizuguchi and his professional staff at Mizuguchi Plastic Surgery in Louisville, KY want you to be prepared. Here is an in-depth look at plastic surgery and insurance, the right questions to ask your insurance provider, and what you need to know so you are better prepared for the financial aspect of your breast augmentation procedure.

What is considered cosmetic vs. medically needed?

When it comes to plastic surgery, what is deemed cosmetic or medically necessary is determined by the insurance company and may even change over time. Reasons for insurance plans changing your coverage:

  • The type of insurance a patient has can change with newly implemented policies or a new insurance provider
  • Evolution of new medical treatments or new procedures
  • Medical research and how it relates to patient needs can affect insurance policies

Most insurance providers follow surgical definitions provided by the American Society of Plastic Surgeons (ASPS) and the American Medical Association (AMA) to distinguish between cosmetic surgery and medically necessary (or reconstructive) surgery. In other words, what they determine to be medically necessary or purely elective. For example, cosmetic surgery is the conventional classification for breast augmentation, as breast implants will enhance and reshape the body to improve a patient’s appearance. Reconstructive surgery is performed on abnormalities in the breasts due to trauma, disease, infection, tumors, or developmental conditions. When breast implants are necessary to improve the function of the breast or give a patient a healthy appearance, insurance providers may fully or partially cover the breast augmentation procedure.

Will insurance cover my breast implants?

In the majority of cases, patients are responsible for paying for their breast augmentation surgery, as breast implants to enhance or alter a patient’s appearance for solely cosmetic reasons are typically not covered. Exceptions are dependent on the reason a patient is getting breast implants in regard to insurance coverage. In general, a patient who needs breast reconstruction with a plastic surgeon like Dr. Mizuguchi allows for insurance to partially or fully pay for the surgery. Breast implants involving reconstruction due to a medical condition like breast cancer, Poland’s syndrome, trauma, or an infection is most likely covered by most insurance plans. Patients considering breast augmentation should check with their insurance provider to determine their coverage.

What important questions should I ask my insurance provider?

Before moving forward with your breast augmentation surgery, it is essential to talk to your insurance provider. Here are five questions to ask your health insurance provider:

  1. Will any of the costs for my breast augmentation procedure be covered?
  2. If I have any complications related to my breast implants, will the necessary treatment be covered?
  3. Will having breast implants affect my insurance rates or coverage if I develop breast problems later?
  4. Will diagnostic tests like MRIs or additional mammogram images be covered after getting breast implants?
  5. Will my breast augmentation surgery affect my health insurance coverage or rates?

In cases where a patient is getting breast implants due to a reconstruction or reduction procedure, insurance may partially or fully pay for the procedure. Breast reduction is one of the rare circumstances that helps women cosmetically change the appearance of their breasts but is covered by most insurance plans. Patients with large breasts endure certain physical limitations and health issues such as back or neck problems. Much like breast reconstruction surgery, a breast reduction can be considered a medical necessity for some women.

If you are considering plastic surgery, it’s important to do your homework and determine your financial responsibility. During your consultation, verify the cost of your breast augmentation, including your surgeon’s fee, anesthesia, and any surgery center costs. The professional, experienced staff at Mizuguchi Plastic Surgery is available to offer assistance to clients in the Greater Louisville area who have insurance or financing questions.

Schedule your consultation at Mizuguchi Plastic Surgery

If you are considering breast augmentation, we invite you to schedule a consultation with Dr. Nana Mizuguchi in Louisville, KY. Dr. Mizuguchi and his team at Mizuguchi Plastic Surgery will answer all your questions about your surgery, and can give you information about financing options if needed. Start your journey toward a fuller, shapelier silhouette today.

breast reconstruction surgery

You may have had or are about to have a mastectomy, either because you’ve been diagnosed with breast cancer or are at very high risk of developing it in the future. If so, your doctor may have told you about options to rebuild your breast or breasts — a surgery called breast reconstruction. Typically, breast reconstruction takes place during or soon after mastectomy, and in some cases, lumpectomy. Breast reconstruction also can be done many months or even years after mastectomy or lumpectomy. During reconstruction, a plastic surgeon creates a breast shape using an artificial implant (implant reconstruction), a flap of tissue from another place on your body (autologous reconstruction), or both. Whatever your age, relationship status, sexual activity, or orientation, you can’t predict how you will react to losing a breast. It’s normal to feel anxious, uncertain, sad, and mournful about giving up a part of your body that was one of the hallmarks of becoming a woman: a significant part of your sexuality, what made you look good in clothes, how you might have fed your babies. No one can ever take that away from you. Moving forward, you now have the opportunity to determine what you want to have happen next. But first you must do some careful thinking and delving into your feelings in order to figure out what is best for you. In this section, we’ll talk you through each of the reconstruction options, what’s involved, and any risks, as well as alternatives to reconstruction. Asking yourself some questions can help you start to think about what type of reconstruction you want — if you want reconstruction at all: How important is rebuilding your breast to you? Can you live with a breast form that you take off and put on? Will breast reconstruction help you to feel whole again? Are you OK with having more surgery for breast reconstruction after mastectomy or lumpectomy? It’s also important to know that while breast reconstruction rebuilds the shape of the breast, it doesn’t restore sensation to the breast or the nipple. Over time, the skin over the reconstructed breast can become more sensitive to touch, but it won’t be exactly the same as it was before surgery. This section of helps you understand your options AND sort through the medical and personal issues around breast reconstruction that you should consider. Is Breast Reconstruction Right for You? Going Flat: Choosing No Reconstruction Prosthetics: An Alternative to Reconstruction When Is Breast Reconstruction Done? Types of Breast Reconstruction Finding a Qualified Plastic Surgeon Questions to Ask Your Surgeon About Breast Reconstruction Paying for Reconstruction Procedures Satisfaction With Breast Reconstruction Results Breast Reconstruction in Women of Color: Tips on Getting the Care You Deserve Corrective Breast Reconstruction Screening After Breast Reconstruction

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