Will Insurance Pay for Removing Breast Implants?

Approximately 20 percent of women who had breast augmentation surgery had their breast implants removed within 10 years, according to the FDA. Some chose to have their implants replaced, while others did not. Some of the common reasons for having breast implants removed included such complications as implant rupture, implant deflation, pain, infection, wrinkling, breast asymmetry and capsular contraction, which is a hardening of the tissue around the breast implant.

Your insurance company typically only pays for surgical procedures which it deems as medically necessary. Cosmetic breast augmentation surgery, which includes removing implants as well as the original insert procedure, is usually considered an elective procedure. Since elective procedures are not medically necessary, most insurance companies won't cover the cost of removing or replacing your implants.

Not all breast augmentation surgery is performed strictly for cosmetic purposes. Breast reconstruction surgery attempts to restore the breast to its natural appearance following a severe trauma, injury or surgery including mastectomy for the treatment of breast cancer. In some cases when only one breast is affected, both breasts might need augmentation to achieve the desired symmetry. Most insurance companies consider breast augmentation that is part of breast reconstruction surgery to be a medically necessary procedure that is a covered benefit. If the original implant surgery was considered medically necessary, the removal of the implants is usually also covered if complications, such as an infection or implant rupture, are present.

If your breast implant extrudes through the skin or if the implant is complicated by recurring infections, your insurance company will likely consider removal of the implant to be medically necessary, regardless of whether the initial implantation procedure was reconstructive or cosmetic in nature. If you have your breast implants removed because you're worried they might cause breast cancer or auto-immune disease, you're probably on your own to pay that bill. Since there is no evidence linking silicone-filled implants to breast cancer, connective tissue diseases or impaired reproduction, insurance companies do not consider having your implants removed as a preventative measure to be medically necessary.