Is corrective breast surgery covered by insurance?

My daughter is 17. As a baby I knew she might need surgery on her left breast. Doctor wanted to see how it developed. Her nipple is under her arm pit and sort of growing in that direction and has no muscle tone at all compared to the right breast. Her breast and nipple are flat. I am unsure about the functionality. Could this be covered by insurance as reconstructive surgery for both look and importantly functionality?

As you know insurance carriers now dictate what is a covered service for surgery. Yes, some insurance plans do cover such reconstructive breast surgery. Consider a consult with a plastic surgeon that takes your insurance plan in your area. I would also suggest you consider looking up Poland's Syndrome.

Best,

Gary R Culbertson, MD, FACS

Gary R. Culbertson MD, FACS
Gary R. Culbertson MD, FACS
18 Miller RdSumterSC29150US

Gary R. Culbertson MD, FACS

Iris Surgery Center, 18 Miller Road, Sumter,
SC, 29150, US

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You are describing what sounds like Poland syndrome in which a child is born with a partial or complete absence if the pectoralis muscle (chest muscle) and often partial non development of the overlying breast tissue. This is considered a birth defect and some insurance companies will pay for this to be corrected at the appropriate age. Unfortunately, some insurance plans will only pay for a congenital (birth defect) problem if it is considered something which causes a functional problem such as a cleft palate and speech or a dislocated hip in Perthes disease etc. So it can unfortunately be an uphill battle with some insurance carriers.

Peter P. Kay MD, FACS
Peter P. Kay MD, FACS
2355 N Wyatt DrTucsonAZ85712US

Peter P. Kay MD, FACS

2355 N. Wyatt Drive, Suite 111,Tucson, AZ,
85712, US

There is a difference between what we consider to be reconstructive to correct abnormalities and insurance benefits. Also this falls under what would be considered reconstructive, depending on your insurance and their list of benefits, it may or may not be covered.

Roberta L. Gartside MD
Roberta L. Gartside MD
1800 Town Center PkwyRestonVA20190US

Roberta L. Gartside MD

1800 Town Center Parkway, Suite 412, Reston,
VA, 22090, US

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Congenital hypoplasia or absence of the breast is abnormal and its correction should be covered by insurance.

Scott L. Spear FACS, MD
Scott L. Spear FACS, MD
5454 Wisconsin AveChevy ChaseMD20815US

Scott L. Spear FACS, MD

5454 Wisconsin Ave., Suite 1210,
Chevy Chase, MD, 20815, US