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Can a Breast Lift Be Covered by Insurance?

Dr. Ludwig Allegra

January 27, 2025

Sagging breasts can be embarrassing and make you look older, but a breast lift is there to help you restore the lost firmness and shape. With the rise in demand for breast lift surgery, many look for insurance coverage to reduce the financial burden. However, the coverage of the surgery depends on various factors like the reasons for the procedure and the insurance provider’s policies. Let’s take a closer look. 

Ferulic Acid

Understanding the Nature of a Breast Lift

A breast lift is primarily performed to address sagging or drooping breasts caused by factors such as aging, weight loss, pregnancy, or breastfeeding. The surgery involves removing excess skin, reshaping the breast tissue, and repositioning the nipples to achieve a more youthful and uplifted appearance. Unlike breast augmentation, which involves implants, a breast lift focuses solely on lifting and reshaping the natural breast tissue.

Because a breast lift is largely considered an aesthetic procedure that is done to enhance the looks and has nothing to do with medical issues, insurance companies generally classify it as elective and do not cover it. However, there are exceptions where medical necessity may warrant coverage.

 

Situations Where Insurance May Cover a Breast Lift

As mentioned, breast lift is considered to be only for aesthetic reasons; however, there are ways to get the insurance coverage, such as:

1. Reconstruction After Mastectomy

If the breast lift is part of breast reconstruction following a mastectomy due to breast cancer, insurance is more likely to provide coverage. In such cases, the procedure is considered medically necessary to restore the breast’s appearance and symmetry.

 

2. Physical Symptoms from Breast Sagging 

In rare cases, severe sagging of the breasts (also known as breast ptosis) can cause physical discomfort. Symptoms may include skin irritation, rashes under the breasts, back pain, neck pain, or shoulder pain due to the weight of the breasts pulling downward. 

If a healthcare provider determines that a breast lift is necessary to alleviate these symptoms, the procedure might be eligible for insurance coverage.

 

3. Breast Lift Combined with Reduction Surgery

When a breast lift is performed alongside breast reduction surgery, there is a higher chance of insurance coverage. Breast reduction is often deemed medically necessary when excessively large breasts (macromastia) cause chronic pain, postural issues, or other health problems. If a breast lift is integral to achieving the desired outcome of the reduction, insurance might cover it.

How to Seek Insurance Coverage for a Breast Lift

If you believe your breast lift may qualify for insurance coverage, here are some steps to take:

1. Consult with Your Surgeon 

Your surgeon can assess your case and determine whether the procedure could be considered medically necessary. They may also provide documentation and a detailed explanation to support your claim.

 

2. Get a Referral 

If physical symptoms like pain or skin irritation are present, obtain a referral from your primary care physician or a specialist. Their evaluation can add weight to your insurance claim.

 

3. Contact Your Insurance Provider 

Reach out to your insurance company to inquire about their specific policies and requirements for coverage. Be prepared to submit medical records, photos, and letters from healthcare providers.

 

4. Prepare for a Pre-Authorization Process 

Most insurance providers require pre-authorization for surgical procedures. This process involves reviewing your case to determine whether the surgery meets their criteria for medical necessity.

Conclusion

While a breast lift is typically considered a cosmetic procedure and not covered by insurance, exceptions exist when the surgery is deemed medically necessary. Reconstruction after mastectomy, relief from physical symptoms, or a combination with breast reduction surgery can increase the likelihood of coverage. 

To maximize your chances, consult with qualified professionals, communicate with your insurance provider, and be prepared to advocate for your needs. Understanding your options and taking the right steps can help you navigate the complexities of insurance coverage for a breast lift.

ABOUT THE AUTHOR

Dr. Ludwig Allegra

Dr. Ludwig Allegra has provided Bellevue, Kirkland, and the surrounding areas with premier plastic surgery procedures for over two decades.