Will Insurance Pay to Have My Breast Implants Removed?

We see many patients in the office who are interested in having their beast implants removed or replaced, especially with the recent media attention on breast implants. They often have been told by their primary care doctors, other plastic surgeons, breast surgeons or their insurance carrier that insurance will pay for all or a portion of the cost of removal and/or replacement.

The first question we ask is if the implants were placed for a cosmetic or reconstructive (e.g. after breast cancer) indication. If placed for cosmetic indications, the answer is “maybe”. If the implants were placed for reconstruction, insurance will usually cover the procedure but the patient would be responsible for their deductible, coinsurance, etc.

If implants are placed for cosmetic reasons, the insurance carrier will usually only consider paying for removal and/or capsulectomy and only for ruptured implants or for painful capsular contracture. This would not include implant replacement or addressing the loose skin or sagging breast tissue that is frequently associated with removing an implant and not replacing it.

The problem with having your insurance carrier cover implant removal is that they will frequently deny payment after the surgery is performed and the patient might be responsible for the surgeon’s fee, anesthesia fee, and O.R. fee which far exceeds the fee that would have been charged if the procedure would have been done as a cosmetic procedure.

Also, as a way to avoid this confusion, we usually don’t charge for removal of implants if a capsulectomy or mastopexy (breast lift) is being done at the same time, as a cosmetic procedure. Our office is happy to answer any questions you might have.

Do I Need to Remove My Textured Breast Implants?

There has been a lot of recent media coverage about breast implants and BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). Many of our patients have come in or called asking about their implants and risk of BIA-ALCL. They ask if their implants need to be removed. The short answer is “probably not”. BIA-ALCL is a very rare lymphoma that is primarily associated with textured implants and also depends on the type of texturing used. Certain brands of textured breast implants have a higher incidence of BIA-ALCL than others but even in this category, the incidence is rare. In patients who are not having any problems that have textured implants, we would not recommend removal or replacement unless there was some other reason to change or remove the implants. It is important to follow up with your plastic surgeon if you have implants especially if you notice any changes in your implants. Implants do not last forever and need to be replaced periodically. That is why periodic follow up (we like to see our patients every year) is so important. It also gives us an opportunity to educate our patients on any new information regarding their implants.

Be Aware Part 3

Be Aware Part 3

Now that we know what it takes to become Board Certified in Plastic Surgery, how do you know if your surgeon is indeed Board Certified in Plastic Surgery? There are a number of ways to check.

*You can ask. Make sure you ask “are you Board Certified by the American Board of Plastic surgery” or “are you Board Certified in Plastic Surgery”. This is very important. Simply being “Board Certified” or board certified by a board other than the American Board of Plastic Surgery is not enough.

*Check the American Board of Plastic Surgery (https://www.abplasticsurgery.org/). There is a link under the “public” tab.

*Check to see if your surgeon is a member of the American Society of Plastic surgeons (ASPS, https://www.plasticsurgery.org/) or the American Society of Aesthetic Plastic Surgeons (ASAPS). In order to be members of either of these organizations, you have to be board certified by the American Board of Plastic Surgery.

Remember, there is no Board Certification for Cosmetic Surgery by the American Board of Medical Specialties.

There are other specialties that perform Plastic Surgery procedures of defined areas such as around the eyes (oculoplastic surgeons) or the head and neck area (Facial Plastic Surgery). Many of these surgeons are excellent and they have their own Board Certifications.

In my next post, I will discuss some of the other organizations that you should be cautious about.