A breast lift can be a life-changing procedure for many individuals seeking to restore their confidence and comfort. However, the question of when a breast lift is medically necessary and whether insurance will cover it tends to hang over the whole thing. The answers can be a bit complicated, so we’re detailing the criteria for medical necessity and instances in which insurance might cover the procedure.
What Is the Purpose of a Breast Lift?
A breast lift, also known as mastopexy, is a surgical procedure designed to provide an aesthetic enhancement by restoring the shape and firmness of the breasts. Due to factors like aging, pregnancy, breastfeeding, and significant weight loss, breasts can lose their shape and firmness over time. A breast lift is an effective way to address these changes and bring back a youthful and perkier appearance.
What Does a Breast Lift Accomplish?
The primary purpose of a breast lift is to restore breast shape and firmness. The procedure involves the removal of excess skin and reshaping of breast tissue to raise the breasts. This results in a more aesthetically pleasing breast contour and the general appearance of the chest area. In some cases, it can also include the resizing or repositioning of the areola to enhance the overall result.
Another objective is to address sagging and drooping, also known as ptosis. This condition can result from the natural aging process, genetics, pregnancy, breastfeeding, or significant weight fluctuations. A breast lift can effectively raise the breasts by removing excess skin and tightening the surrounding tissue, improving the profile of sagging breasts and making them look more lifted.
When Is a Breast Lift Medically Necessary?
At times, medical conditions necessitate a breast lift for reasons beyond aesthetics. Some might require a breast lift to address issues like physical discomfort or pain. Chronic skin irritation beneath the breasts, shoulder indentations due to bra straps, or the inability to perform physical activities due to breast size can all be reasons that make a breast lift medically necessary.
Factors such as chronic back, neck, or shoulder pain due to the weight of the breasts, or recurrent skin infections under the breast hold weight when considering medical necessity. In such situations, it’s not merely about improving the appearance; it’s about enhancing the quality of life.
What Constitutes Medical Necessity?
Medical necessity is defined by specific criteria set by insurance companies. These often involve the presence of symptoms caused by the size or position of the breasts that interfere with everyday life and cannot be resolved by non-surgical means.
Examples of conditions that meet these criteria include macromastia (abnormally large breasts), breast asymmetry due to lumpectomy or mastectomy, and chronic and severe physical discomfort. Any condition that causes significant impairment or discomfort can be considered a valid argument for medical necessity.
When Would Insurance Cover a Breast Lift?
Typically, insurance companies categorize breast lift surgeries as cosmetic procedures and refuse to cover them. However, in cases where the surgery is deemed medically necessary, insurance might cover part of or the entire procedure. To a degree, this will all come down to your specific insurance policy, so read up and consult your provider and surgeon.
What You’ll Need to Prove a Medical Necessity
Documentation is important for convincingly arguing medical necessity. This includes a detailed report from your primary care physician or a specialist outlining the physical symptoms and discomfort you experience due to your breasts. You may also need photographs as visual evidence, a list of all non-surgical treatments attempted, and statements from physical therapists or chiropractors if you’ve sought treatment for back, neck, or shoulder pain.
Get an Initial Consultation With Our Surgical Team
A breast lift procedure can help to augment the shape and position of your breasts for aesthetic and comfort reasons. In most cases, insurance won’t cover this procedure, but if you’re able to prove the medical necessity of it because of the discomfort caused by your breasts as they exist now, there may be a chance.
When seeking insurance coverage for your breast lift surgery, it helps to consult with an experienced surgeon in the field. The Prestige Plastic Surgery team can help you understand the process, answer all your questions, and assist with gathering the necessary documentation. To schedule a consultation, contact us on our website.
Image Credit: New Africa, Shutterstock
