Can You Use Insurance for Breast Explants?

Women who get breast augmentation surgery spend an average of $6,500. This includes operating room costs, surgeon's fees, and anesthesia. Most patients pay out of pocket as insurance usually does not cover the treatment. Sometimes, implants may cause health problems and require removal. If you want to have your implants removed as a medical necessity, insurance may cover the cost.

breast explant

Reason for Augmentation

Insurance companies often assess the reason for getting implants when determining whether to pay for explants. Your doctor may recommend breast implant removal as a medical necessity. If the implants were due to a mastectomy from breast cancer, the insurance is obligated to pay for removal. For breast augmentation on healthy breasts, some insurance companies will cover the explant procedure if the implants are negatively affecting your health.

Medically Necessary Services

Insurance companies determine services to be medically necessary when they are required to treat an illness. The companies do not always agree with doctors on what is medically necessary. Breast implant removal is medically necessary for certain conditions, including:

  • Severe capsular contracture

  • Ruptured breast implants

  • Chronic breast pain or back pain from implants

  • Breast implant-associated cancer

  • Chronic breast tissue infections

Unfortunately, insurance companies do not usually cover implant removal from systemic complications, such as autoimmune or connective tissue disease.

Letter of Medical Necessity

If you want breast removal for medical reasons, you need a letter of medical necessity. The insurance company will refer to the letter to decide whether to pay for it. The letter can determine whether you get the coverage you need.

It is necessary to know that most plastic surgeons do not have the relevant experience to write letters. Unfortunately, the insurance company can deny coverage if they find the reasons unconvincing. Thus, you should consult your primary care physician or specialist and obtain the letter through them.

Letters for Breast Explant Patients

Most insurance companies cover the cost of implant removal for the reasons discussed above. However, some augmentation patients require breast explants due to other conditions. If you have issues such as autoimmune disease symptoms or seromas, you need a letter to explain your condition.

You must convince the insurance company that your symptoms require implant removal as a medical necessity. The surgeon can find a compelling way to convince the insurance company you need the surgery. It can maximize your chances of getting coverage.

Personalized "Medical Necessity" Letters

It is crucial to ensure you get a personalized medical necessity letter. It is not enough to print a sample letter for use as it is. The samples provided are usually broad, but you need a letter tailored to your specific situation.

The letter needs to reflect your symptoms accurately. Personalizing the letter will make it strong as it captures your case. You can get expert guidance from

For more on if you can use insurance for breast explants, contact Aesthetic Surgical Associates at our Metairie, Louisiana office. Call 504-226-8200 to schedule an appointment today.