Will Insurance Pay For New Breast Implants If They Are Encapsulated?

Q: Dr. Eppley, Can silicone implants be replaced and the procedure partially paid for by your insurance company if they are entirely encapsulated?

A: No physician can tell you for sure whether your health insurance company will cover any plastic surgery procedure. There is a process known as predetermination which makes that decision about any elective non-urgent procedure. This requires a written letter by the plastic surgeon to the insurance company with the medical issues, diagnosis and proposed surgery outlined. The insurance company will then review it and make its determination to you, a process that will take at least several weeks.

That being said, a general rule is that insurance will not pay for any implant-related plastic surgery procedures in which the implant was not initially placed for a medically necessary reason. This refers to breast reconstruction procedures with an implant done to restore a breast partially or fully removed after cancer. It is unlikely that capsular contracture in breast implants placed for cosmetic reasons, unless there is evidence of an implant rupture, would be covered.

Dr. Barry Eppley

Indianapolis, Indiana