Q: I had a breast augmentation about 10 years ago. I felt that they were too big right after surgery but my doctor somehow convinced me to keep them at the time. I would them either downsized or completed removed with some type of lift done at the same time. My question is what are the chances of my insurance covering a breast reduction or at least part of it? Have you ever dealt with a situation like this?
A: The simple answer is that this is not a procedure that would be covered by one’s health insurance. While the breasts are being downsized, this does not constitute a medically necessary breast reduction as implants are being removed, not breast tissue. The premise of a true breast reduction is that there is too much breast tissue present and a certain amount must be taken out. A medically necessary procedure has at its origin a health or medical cause. Prior breast augmentation is a cosmetic cause not a medical one. Breast implant removal and any lift that may be associated with it to reshape the loose and sagging breast skin is a cosmetic procedure.
Dr. Barry Eppley