Is Breast Lift Surgery Cost Covered Under Insurance?

When is Breast Lift Considered a Medical Necessity?

Breast Lift is considered a medical necessity when the sagginess causes physical discomfort and pain and makes it difficult for individuals to function normally. Additionally, the surgery might be deemed medically necessary if the sagging breasts affect the person’s quality of life and mental well-being. Some conditions that make breast lift surgery an absolute necessity are:

Sagging breasts that cause chronic pain –  Too much sagging of the breasts can lead to physical discomforts such as pain in the back, neck, and shoulder. The weight of the breasts continuously pulls the body downward which in turn can lead to long-term body pain. Breast lift surgery can be an effective treatment as it lifts and reshapes the breasts to an appropriate position.

Difficulty performing daily activities – Severe breast sagging can cause breast ptosis which can hinder daily physical activities, affect proper posture, and affect the person’s ability to carry on normal daily tasks. Breast lift may be considered a medically necessary treatment to restore functionality of the body and improve well-being.

Skin infections and irritations – Sagging breasts can create skin folds and friction, leading to irritation, rashes, or even infections in the folds under the breasts. A breast lift suregry may be recommended to remove excess skin and reduce the risk of further complications.

It is essential to consult with a qualified healthcare provider to determine whether breast lift surgery is medically necessary or not. Along with the doctor’s version, insurance companies may have their criteria for determining medical necessity for breast lift suregry, which may vary depending on the policy and the healthcare provider.

When is Breast Lift a Cosmetic Concern?

Breast lift surgery is considered only a cosmetic concern when the sagging breasts do not cause any health issues but the person is dissatisfied with the appearance of their breasts. Breasts, over time, may lose their firmness and start to sag due to reasons such as aging, generics, weight fluctuations, hormonal changes, pregnancy, or ill-fit bras. A breast lift surgery may give a toned and lifted appearance to the breasts. The breasts may lose volume, as a woman ages, resulting in a deflated or flattened appearance of the breasts. In such a case, the plastic surgeon may reshape the breast tissues along with the nipples.  

Many individuals seek cosmetic breast lifts to enhance their self-esteem and body image. Feeling unhappy or self-conscious about the appearance of one’s breasts can have a significant impact on overall well-being and quality of life.

In such cases where breast lift surgery is considered purely a cosmetic treatment and the treatment is not associated with any health concern, insurance coverage for breast lift surgery may not be possible. It’s essential for individuals considering a breast lift to consult with a qualified plastic surgeon who can assess their concerns, discuss their options, and help them make informed decisions about their treatment.