Most often surgeries that are considered cosmetic or elective are not covered by insurance. Typically, a surgery is required to be deemed “medically necessary” for insurance companies to cover the cost. 

A breast lift, also known as mastopexy, raises the breasts by removing excess skin and tightening the surrounding tissue to create a more youthful breast contour. A breast lift raises the breasts, and often repositions the nipple, to sit higher up on the chest. A breast lift does not add or decrease volume as the breast is reshaped with existing tissue. As breast lifts are primarily performed due to cosmetic reasoning, sagging or drooping of the breasts, insurance does not cover a breast lift. There are a couple of instances, though, where insurance may cover a breast lift: congenital deformity or tuberous breast deformity and breast reconstruction due to cancer procedures or mastectomy. 

On the other hand, a breast reduction is where a surgeon removes excess fat, tissue and skin to reduce a patient’s overall breast size. Most women choose a breast reduction,  mammoplasty, to reduce the size of their breasts to alleviate pain or to achieve a more proportionate size. However, sometimes there are necessary reasons for a breast reduction such as chronic nerve pain, rashes under breasts, abnormal curvature of the spine, limitation of physical activities or tingling of the extremities. If your breast reduction surgery is considered medically necessity, it is possible a health savings plan (HSA) or insurance policy may cover surgery expenses with a diagnosis letter provided by your physician outlining that the surgery is needed to treat an illness or disease and not for cosmetic purposes. Most insurance providers will request an additional 6 to 12 months of documentation, along with treatment by a physical therapist, chiropractor, dermatologist or orthopedist to ensure other treatments have been ruled out before approving surgery. Keep in mind that most insurance companies also require meeting a pre-determined threshold or deductible before paying for surgery expenses, if approved. 

Often, a breast lift and a breast reduction can be performed at the same time. The good news is that performing the surgeries together are efficient for recovery and results. Even better news, insurance may in fact cover one or both procedures if undergone at the same time because breast lifts can aid in the success of breast reduction surgery. However, the only way to be sure is to contact your insurance provider directly. 

Whether or not your breast lift is covered by your insurance, ask your surgeon’s office about financial arrangements. You can explore your doctor’s financing options which may include setting up a payment plan, a discount on paying the full amount at the time of service or obtaining a medical credit card such as Care Credit with no interest rate. 

David W. Allison, MD specializes in breast lifts, breast reductions and breast reconstruction. If you’d like to know if insurance will cover your procedure or have any additional questions, our dedicated and friendly staff is here to help. Give us a call today at 703-754-8228 or schedule your consultation online at WEBSITE.