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.