Does Insurance Cover Plastic Surgery?

Does insurance cover plastic surgery?

One of the first questions people ask when considering treatment is, “Does insurance cover plastic surgery?” The answer is “Sometimes, depending on the circumstances.”

Insurance will most likely cover plastic surgery if the procedure is deemed “medically necessary” and has the appropriate documentation backing it up.

Differences Between Plastic Surgery and Cosmetic Surgery

One way to start thinking about whether insurance will cover your surgery is to decide if you want cosmetic surgery or need plastic surgery. While these two terms are often used interchangeably, specific and technical differences exist between them.

Plastic Surgery vs. Cosmetic Surgery

Plastic Surgery

Plastic surgery is a broad medical specialty focused on reconstructive surgeries to restore or improve function. Interestingly, the name of the specialty derives from the Greek word, Plastikos, which means “to mold” or “to form.”It is often used in cases of injury or trauma to improve or restore a person’s natural shape and anatomical function.

Plastic surgeries include:

  • Breast Reconstruction

  • Skin Grafting

  • Cleft Lip/Cleft Palate Repair

  • Trauma Reconstruction

  • Rhinoplasty (to improve breathing)

Cosmetic Surgery

A subset of plastic surgery that focuses specifically on improving the aesthetics of a person’s appearance. 

Elective surgeries include:

Ultimately, the decision to undergo mastectomy for DCIS is a personal one that should be made in consultation with your oncologist and plastic surgeon. You will need to discuss the risks, benefits, and potential outcomes of all treatment options so you can make a truly informed decision that matches your case presentation and goals.

Should You Get a Double Mastectomy for DCIS?

While not truly a prophylactic mastectomy since DCIS is an early breast cancer diagnosis, deciding on a mastectomy for DCIS treatment has many of the same considerations and offers many of the same benefits.

The main benefit is that you and your plastic surgeon can plan your mastectomy with your final reconstruction results in mind. Getting a double mastectomy for DCIS followed by an immediate reconstruction means you never have to know a time without having breasts.

Like all surgeries, there are many pros and cons to weigh, but women who choose mastectomy and work with a plastic surgeon from the outset almost never regret their decision.

Another benefit to consulting early with your plastic surgeon is being able to choose the right type of mastectomy and reconstruction to match your desired treatment outcomes.

When Does Insurance Cover Plastic Surgery?

Breast Reduction

Breast Reduction Surgery

Breast reduction surgery is considered medically necessary when patients have specific symptoms that don’t resolve with conservative treatments and they meet the Schnur scale requirements

These conditions typically include shoulder grooving, chronic skin irritation beneath the breasts, or chronic neck or mid-back pain

You will need documentation of these conditions and the methods you have used to try and treat them before surgery.

Breast Reconstruction

An icon showing surgical lines on the breast.

Breast reconstruction is considered medically necessary after cancer diagnosis and mastectomy, or prophylactic mastectomy, both New York state and federal laws mandate insurance companies cover it. 

Reconstructive surgery is also covered after breast conservation surgeries like lumpectomies or oncoplastic reductions.

All aspects of breast reconstruction related to cancer are covered by insurance, including areola and nipple reconstructions, breast reconstruction revision surgery, or aesthetic flat closures.

Mohs Reconstructive Surgery

Mohs Surgery Reconstruction

If Mohs surgery was needed to remove skin cancer, and that procedure was covered by insurance, then reconstructive surgery would also be covered by insurance.

Your plastic surgeon can work closely with your dermatologist to use specialized techniques immediately after removing the cancerous tissue. Plastic surgery techniques to close these wounds can help patients avoid deformities and improve scar appearance.

Septoplasty 

Rhinoplasty is a surgery designed to change the nose's size, shape, and appe

Septoplasty may be considered a medically necessary surgery and covered by insurance if someone has documented severe airway obstructions due to a deviated septum or previous injury.

Scar Revision Surgery 

Scar Revision Surgery

Scar revision surgery involves releasing the scar deformity and rearranging the tissue to change the tension of the skin, which is occasionally covered as a standalone medical issue. 

Scar revision is typically covered if the scar causes discomfort or impacts function (like a scar on your cheek preventing you from fully opening your eye).

Harris Plastic Surgery Works With Your Insurance Whenever Possible

At Harris Plastic Surgery, we are familiar with the intricacies of insurance coverage for plastic surgery. We can walk you through your options so you can get the treatment you need and the most from your insurance coverage. 

Harris Plastic Surgery - Your Breast Reduction Experts

If you are wondering, “Does insurance cover plastic surgery?” The experts at Harris Plastic Surgery are here to help you find out. Call or text anytime 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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