Can a Breast Augmentation be Covered by Insurance?

Can a Breast Augmentation be Covered by Insurance?


No matter your reasons for wanting breast augmentation surgery, you want to be informed about the cost. Many factors go into a surgeon’s pricing for the procedure, including his or her experience, the type of augmentation, and what part of the country the medical office is located in.

Often, patients want to know if they can get their breast augmentation surgeries covered by insurance. According to the American Society of Plastic Surgeons, most health insurance plans will not cover cosmetic breast augmentation costs, related complications or revision surgery.

However, there are circumstances in which your insurance will pay. If your surgery is considered reconstructive rather than cosmetic, it may be covered.

Cosmetic Breast Augmentation

Cosmetic surgery is any augmentation done solely for appearance’s sake. If you are looking into breast augmentation to look better in your swimsuit, your surgery would be considered cosmetic. Other examples of cosmetic surgeries include nose jobs done to reduce the size of the nose; other implants, like chest or calf; and anti-aging facial treatments, like a facelift.

There are many valid reasons you may seek any of these surgeries, and you have many options to choose from. But if they have no medical purpose, then insurance will not cover them.

Reconstructive Breast Augmentation

However, if you have a medical need for your breast augmentation it will likely be covered. Plastic surgery for medical purposes is known as Breast reconstructive surgery. Insurance coverage will depend on the type of reconstructive surgery you are having and will vary by insurance company.

Reconstructive surgery not only covers “functional disabilities” but also “deformities.” Therefore, breast augmentation after mastectomy (removal of one or both breasts due to breast cancer) is considered reconstructive and is covered.

Evolving Definitions

The terms used to define what is cosmetic and what is reconstructive are constantly evolving. For example, “deformity” does not only mean reconstruction of the breast that has undergone mastectomy, but also the reconstruction of the other breast so it matches in appearance.

After undergoing reconstruction for these purposes, women can also be covered for elective revision surgery (choosing to undergo more surgery sometime later) for aesthetic reasons. They may want to enhance the look of their breasts using a different surgical approach or replace an older type of implant.

Keep in mind each patient must work with their insurance company to determine what the company is willing to cover. Some companies will continue to cover breast implant revision surgery as long as eight years after the initial reconstruction, while others may only do so for a short period afterward.

“Lifetime Warranty”

Most breast augmentations — whether cosmetic or reconstructive — now come with a “lifetime warranty.” Sometimes, a doctor finds implants to be faulty after they have been placed, as seen in cases of leaking implants. Insurance will pay for the replacement surgeries for patients in these circumstances, with implant manufacturers replacing the implants for free. (Some manufacturers even cover operating room expenses for 10 years post-surgery.)

Linville Plastic Surgery

Dr. Cain Linville is a double-board certified plastic surgeon specializing in all surgical and non-surgical procedures in Houston. He and his team at Linville Plastic Surgery provide the top results in Texas and the United States with an unmatched safety rating. Linville Plastic Surgery provides a boutique, personalized experience to all patients using the latest practices and technology.

Call 713-300-2567 or submit a message here to contact
Linville Plastic Surgery today!


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