When Is A Breast Lift Covered By Insurance

The American Society of Plastic Surgeons says a breast lift, also known as mastopexy, raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. This page's own wording is that a breast lift, or mastopexy, is designed to raise and reshape sagging breasts. The causes named here are age, childbirth, and weight fluctuations. Pregnancy, breastfeeding, gravity, and heredity are on that society list and are not the causes given here. The same description says breast lift surgery does not significantly change the size of your breasts or round out the upper part of your breast. This page does not use that size limit as its own rule.

The American Society of Plastic Surgeons is also said, on this page, to have reported a significant rise in breast lift procedures performed each year. No count and no year are attached to that rise. Better technique, more awareness, and wider acceptance of plastic surgery are the reasons offered. Those reasons are this page's account of the rise, not a numbered table.

One sentence says insurance will cover this surgery in either of two situations. The first is if you are seeking a breast lift. The second is if you require a breast lift to allow for the asymmetry procedure of the contralateral breast following breast reconstruction surgery for breast cancer. The word between those situations is or. Seeking a lift, by itself, is written as enough for coverage in that sentence.

A later account says breast lift surgeries are typically categorized as cosmetic, with an exception. If a woman has undergone a mastectomy due to breast cancer and seeks a breast lift as part of her reconstruction, the lift might be considered reconstructive and therefore covered. Will cover, from the earlier sentence, and might be considered, from this one, both stay. Mastectomy is named only in the might-be-considered account. The will-cover account names breast reconstruction surgery for breast cancer and the contralateral asymmetry procedure.

The patient's breast lift you can see here was not covered by insurance. The case shown is a bilateral breast lift and augmentation to correct sagging breasts and a slightly lowered nipple placement. Please see this 39-year-old female status post bilateral breast lift and breast augmentation with moderate profile 270 cc silicone implants. The uncovered case and the 39-year-old, 270 cc, moderate profile line are both on the page. The photographs are not each labeled with that age or that implant.

The size sentence from the society description sits next to this case without replacing it. A lift that does not significantly change size is the society wording. This case adds augmentation, and it names moderate profile 270 cc silicone implants. Slightly lowered nipple placement is the nipple finding in the uncovered-case sentence. No nipple measurement is given.

This page says the American Medical Association defines cosmetic surgery as work that enhances appearance. The goal it assigns is aesthetic appeal, symmetry, and proportion. Those procedures are called typically elective. The examples are breast augmentations, facelifts, liposuction, and nose reshaping.

Reconstructive surgery, on the same account, treats structures affected by congenital defects, developmental abnormalities, trauma, infections, tumors, or disease. It is said to improve function and, to a lesser degree, to approximate a normal appearance. The examples are breast reconstruction after a mastectomy, cleft lip and palate repair, and surgery after burns. The page presents these as the association's definitions. Insurers are then said to use their own criteria: the patient's health history, the details of the plan, and the nature of the procedure.

A breast lift is placed in a gray area. It can be called cosmetic in one setting and reconstructive in another. The example is a lift after significant weight loss, considered for coverage when medical necessity is shown, such as chronic back pain or skin infections due to sagging breasts. That example is sagging after weight loss. It is not the cancer-reconstruction sentence, and it is not the large-breast example used later for prior treatment.

For a procedure in that gray area, the page says medical necessity has to be proved, in three steps. Documentation comes first: medical records, photographs, and letters from a primary care physician or a specialist. No form name and no required photo count are given.

Insurers are said to want evidence of non-surgical care first. The example is a woman with back pain due to large breasts, who might need to show physical therapy or pain medications without success. Large breasts are the example. Sagging is not the word in that sentence. Before approval, the insurer might also require consultation with one or more plastic surgeons, to judge whether the procedure is necessary and viable.

All costs can be discussed with the insurance company so it is clear which procedures will be covered and which costs the patient would pay. That discussion is with the insurer. No fee for a lift is stated on this page.

The proof steps do not assign those statements to a single form. Records, photographs, and letters are the documentation step. Prior physical therapy or pain medication is the non-surgical step, and the example for that step is back pain from large breasts, not from sagging. One or more plastic-surgery consultations are the third step. The insurer is also where the page sends the question of which procedures are paid and which costs remain the patient's. NaturaBra™ is not given an insurance status. It is named as Dr. Paris Sabo's technique, using the patient's tissue as an internal bra, with enhanced results and minimal scarring. The shown operation remains a bilateral lift plus augmentation, with sagging, a slightly lowered nipple, and the separate 270 cc moderate profile line.