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Topic: Will insurance cover a revision

Forum: Breast Reconstruction —

If you've had or will be having a mastectomy (or in some cases, lumpectomy), you're likely facing decisions about whether or not to have breast reconstruction, and if so, what type and when. Deciding whether or not to have a breast reconstructed is a very personal choice. Take the time you need to learn about how breast reconstruction might affect you, both emotionally and physically, before you decide to have the surgery.

Learn about different surgical options and the medical and personal issues around breast reconstruction.

Intro medically reviewed by: Brian Wojciechowski, M.D.
Last review date: November 22, 2020

Posted on: Mar 14, 2021 08:30PM

LBG10 wrote:

Iam almost 2 yrs post reconstruction. I had 8 surgeries total to complete my reconstruction. My question is, does insurance typically cover the cost if I choose to do another revision to swap my implants for a smaller size? Iam not happy with the size, they are too big and uncomfortable. I had no issues with my insurance during my initial reconstruction, but I didn’t know if it’s considered “cosmetic” now?

Has anyone else done this

thank you for any input


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Mar 14, 2021 09:22PM sbelizabeth wrote:

Yes, insurance will cover it. No, It's not cosmetic. My plastic surgeon's assistant in charge of insurance pre-authoriazation said "all I have to include is 'breast cancer' and they will cover it."

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Mar 15, 2021 06:41AM Rah2464 wrote:

Yes your insurance should cover the revision surgery. I hope you can pursue and get a better outcome. I had a revision surgery 2 1/2 years from my initial surgery. My PS removed a ton of scar tissue that had formed - so much better now.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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