How Much Does Breast Reconstruction Cost?

By: Dr. Minas Chrysopoulo

Blogs
May 10, 2010

The two most common questions among breast cancer patients considering breast reconstruction are "how much does breast reconstruction cost?" and "will my insurance cover it?"

The good news is that even though breast reconstruction is performed by plastic surgeons, it is NOT considered cosmetic surgery. If the mastectomy is for breast cancer then the law states it must be covered by insurance. If the mastectomy is covered, the reconstruction will be too. The bad news is that even though insurance covers breast reconstruction, there are still some costs that the patient will be responsible for. Patients much research this ahead of time to limit the risk of a nasty financial surprise down the line.

While the degree of coverage varies based on the insurance plan, there are some things that are pretty standard. Effective June 1, 2010 even Medicaid will provide a benefit for breast surgery to the unaffected breast for symmetry, providing certain criteria are met. Breast reconstruction after prophylactic (preventive) mastectomy is usually covered as long as the patient is deemed to be high risk for breast cancer (significant family history or BRCA gene positive).

Even though insurance companies are mandated to cover reconstruction, breast reconstruction insurance laws do vary by state. The amount each insurance pays can also vary a great deal. It is important to make sure your surgeon is in-network for your insurance plan if at all possible. This will limit your costs to whatever you've agreed to pay under the terms of your insurance plan (such as your deductible, co-pay and out of pocket expense). Using an out-of-network surgeon will likely subject you to other costs such as "balance billing". This is when the surgeon essentially sets his/her price (just to use an example let's say $1,000), receives whatever the insurance plan pays (let's say $600) and then asks the patient to pay the remainder (ie the "balance" of $400). This example is based on relatively small dollar amounts but you can see how this could add up to tens of thousands of dollars of additional bills for a major surgical procedure, and that's just for the first procedure.

Whether or not you can nd an in-network, experienced surgeon depends on the procedure you've decided to have. If you've decided to have an implant reconstruction then you may have several doctors to choose from. Implant breast reconstruction is technically not as challenging as other options and most plastic surgeons perform the procedure.

On the other hand, if you're more interested in an advanced reconstructive procedure that not many surgeons offer (like a DIEP flap), you're likely to have a harder time finding an experienced surgeon to perform your surgery who is in-network. Most patients will unfortunately have to travel for their surgery because of this. Even though this may now add the cost of airfare and hotel stays, these costs are typically significantly less than a "balance bill" from an out-of-network surgeon.

Some breast centers even offer special arrangements to traveling patients such as significantly discounted hotel charges to help ease the financial burden.

Learn More About DIEP Flap Breast Reconstruction

4 Comments

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  • Amber

    Seeking advice for reconstruction of my breast. Left breast is a D right breast is a B, both have no density. I cannot find a bra to fit me. I look lopsided and my left shoulder goes numb at times.

    Reply
  • PRMA Plastic Surgery

    Good morning Amber! To properly recommend options for breast reconstruction, you should be evaluated by a board certified plastic surgeon. You are more than welcome to give us a call at 210-692-1181 to schedule, or you can fill out our virtual consultation form at http://prma-enhance.com/patient-forms/virtual-consultation

    Reply
  • Amanda

    Hi, I would just like a rough idea how much breast reconstruction costs. I just want my breast lifted and put back where they were in my 20s :o) Im 51 and single and very concious of them as they are very empty and droopy

    Reply
  • PRMA Plastic Surgery

    Hi Amanda! It is hard to give a cost estimate on this type of procedure because it can vary a great deal between patients. We would be more than happy to get you scheduled for a consultation to come see us, so we can give you a better recommendation! You can also read more about our breast procedures here: http://prma-enhance.com/cosmetic-surgery/breast-procedures. If you would like to schedule a consultation you can give us a call toll free at 800-692-5565.

    Reply
PRMA Plastic Surgery