Does Insurance Cover Fat Grafting for Breast Reconstruction?

Does insurance cover fat grafting for breast reconstruction

When initially faced with the need for a mastectomy and breast reconstruction, having adjunct procedures to get the best aesthetic outcomes may be the furthest thing from your mind, let alone wondering whether or not those procedures will be covered by insurance. Knowing all your options upfront can be a source of comfort once you’ve had time to understand the wide range of reconstructions available.

One of those adjunct options is autologous fat grafting. Fat grafting (also called fat transfer or lipofilling) can improve the look and feel of breasts after a lumpectomy or reconstruction. So what exactly is fat transfer, and does insurance cover fat grafting for breast reconstruction surgeries?

Fat Grafting to Improve Breast Reconstruction Outcomes

Fat grafting begins with removing your own fatty tissue using liposuction, typically from the thigh, abdomen, or buttocks. The tissue is processed and immediately injected into the chest area to achieve a more natural look and feel to the breast after reconstruction. The procedure is typically done months after the primary reconstructive procedure.

Fat grafting is especially effective in correcting:

  • Skin rippling above implants
  • Skin dimpling
  • Excessive skin firmness after radiation
  • Asymmetry between reconstructed breasts (or the reconstructed and remaining breast)
  • Blending the contour around implants — especially along the upper pole where implants can be the most noticeable.
  • Augmenting the volume of natural tissue reconstruction without using implants.

Cases where fat grafting is the sole means of reconstruction have been successful but require multiple stages and, at times, pre-expansion of the chest wall tissue using an external breast expander. While considered medically necessary by the American Society of Plastic Surgeons, a full reconstruction using this method alone is difficult to do and requires a cumbersome external chest wall expander called a BRAVA device.

Does Insurance Cover Fat Grafting for Breast Reconstruction Surgery?

Because of the Women’s Health and Cancer Rights Act of 1998 (WHCRA), federal law requires most insurance companies that cover mastectomies also to cover all breast reconstruction procedures associated with the mastectomy or lumpectomy. This requirement includes procedures like:

The coverage also extends to aesthetic procedure options like nipple and areola reconstructions. But does insurance cover fat grafting for breast reconstruction aesthetic improvement? In most cases, yes.

Timing is not a factor in deciding if your reconstruction surgery is covered under the WHCRA guidelines. While most women undergoing prophylactic mastectomy choose to do immediate reconstruction, women who have breast reconstruction following cancer diagnosis might opt to wait until later to focus on regaining their health first. Regardless of your timing, your breast reconstruction after mastectomy should be covered by most insurance carriers.

That being said, some insurance providers are exempt from WHCRA mandates. Medicare, Medicaid, and insurance provided by a religious institution or governmental agency may cover mastectomy procedures, but they do not have to cover breast reconstruction. Even though they’re not obligated to do so, providers like Medicare may elect to cover breast reconstruction if the mastectomy is deemed medically necessary.

How To Get The Most From Your Insurance Coverage

There are many ways to get the best outcomes from your breast reconstruction while also limiting the amount of money you spend out-of-pocket.

Ways To Improve Your Experience While Limiting Your Costs

Work with an insurance coordinator

One of the easiest ways to get the most from your insurance coverage is to work with an office that has a specific insurance coordinator. This staff member will act as your liaison between your plastic surgeon, breast surgeon, and insurance company to help you navigate the world of treatment options and billing codes. They will help you negotiate prices and gain necessary pre-authorizations for your procedures.

Explore different techniques

Procedure costs can vary greatly depending on whether you do a reconstruction using implants or flap surgery. Consulting with an expert plastic surgeon can help you find the best treatment options to balance your desired results with your insurance coverage and personal expenses.

Be open to out-of-network providers

While in-network providers are often thought to be the cheaper and easier option, there can be many benefits to looking outside your network. For medically necessary procedures, the differences between providers might be insignificant, and working beyond your network could give you access to the plastic surgeon of your choosing, with vast clinical experience and expertise.

Know your risks

Insurance is more likely to cover medically necessary procedures. Knowing your specific risk factors for developing breast cancer or having an official breast cancer diagnosis can increase the chances of having your mastectomy and reconstruction procedures covered by your insurance provider. 

Coordinating treatment through a plastic surgeon

Many people assume an oncologist or breast surgeon needs to be the primary coordinator of mastectomy and reconstruction procedures, but coordinating your care through a plastic-surgeon-first consult, specifically in the case of prophylactic mastectomy, can give you one point-of-contact from start to finish on your reconstruction journey. Plastic surgeons can connect you with the best breast surgeon and help you plan your mastectomy with your reconstruction options in mind. 

Meeting with a plastic surgeon early during your mastectomy and reconstruction planning can provide you with a sense of control and comfort, knowing you have options available and an expert team beside you. 

Harris Plastic Surgery Experts in Breast Reconstruction and Revision

Harris Plastic Surgery is an excellent choice when you’re looking for breast reconstruction surgery or revisions. We can help answer all your insurance questions, including “Does insurance cover fat grafting for breast reconstruction and revision?” To learn more about breast reconstruction, revision, and autologous fat grafting, call or text our office to schedule your consultation. 

Joanne Parrinello, Practice Manager

Joanne Parrinello is an expert patient care coordinator, with two decades of experience navigating the complex financial side of medically necessary breast reduction and reconstruction surgery. She acts as a guide to patients, helping them understand their options and their expected out-of-pocket expense. The insurance industry can be complex and filled with jargon that makes you feel like you need a translator. At Harris Plastic Surgery, Joanne is that translator.

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