How much does breast reconstruction cost?
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 must 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 find 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.
Author: Dr. Minas Chrysopoulo
The good news is that even though breast reconstruction is performed by plastic surgeons, it is NOT considered cosmetic surgery.
Leave Comment
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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
July 17,2020
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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 https://prma-enhance.com/patient-forms/virtual-consultation
July 17,2020
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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
July 17,2020
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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: https://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
July 17,2020
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I want to know about the cost of diep flap reconstruction surgery of breast. I’m Indian but my keen desire that come to prma plastic surgery center and reconstruct my breast so plz give me advice and help me. Thanks.
July 17,2020
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I’ve had to different capsule of my breath where they have hardened. Now I have taken the implants out for 8 months and I have so much shrinkage on one and scar tissue on another that after seeing 3 plastic surgeon all said I need a reconstructive surgeon. Do you think I could be covered for this through my ins even thou it was caused by cosmetic surgery? Breast implants
July 17,2020
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So sorry to hear you are going through all of this. Sadly, in most circumstances insurance will not cover the cost of additional surgery needed after implant complications for implants that were placed cosmetically.
July 17,2020
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Please I would like to have an estimate for unilateral DIEP delayed breast reconstruction surgery.
I am in Canada and my insurance will not pay if done outside my province and my country.
I am aware that each surgery is different but in general how much it cost approximately.
Thank you in advance,
September 24,2020
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Thanks for reaching out May! You are correct that every surgery is different and as such it is difficult to give a proper cost estimate for a patient paying out of pocket. We would need to evaluate your needs and develop a personalized surgery plan before providing a cost estimate. We would be more than happy to schedule you a virtual consultation so you can meet with one of our board-certified plastic surgeons from the comfort of your home. You can fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
September 25,2020
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I had double mastectomy and nipple removal and I’m looking what’s the cost for Diep flap and if it would be recommended.
I had cancer in my left breast. Lately I’ve started getting small fatty lumps and my left implant flip inside my breast. My breast are very uneven and I have consults with my doctors whom recommend me to have more fat transfer done
September 29,2020
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Thanks for reaching out Veronica! We would be more than happy to evaluate your needs and provide you with our surgical recommendations along with a cost estimate based on your insurance patient responsibility requirements. We welcome you to fill out our virtual consultation for at https://prma-enhance.com/schedule-a-consultation/
September 29,2020
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Hello I am writing today for my Sweet friend. She didn’t opt for a Masctomy when she was diognosed with her breast cancer. Then she found out that is she had done a Masctomy then her insurance would have paid or helped. It’s so sad you think you are doing the right thing because I cannot imagine how scary it would be to choose to have a Masctomy when the surgeon says otherwise. She is disfigured from all the surgery that was done. She told me a couple of weeks ago that she is Grateful to have survived the cancer and Radiation but she is Depressed because she is disfigured now. Her husband is cheating on her and this only added to her worthlessness… I just wanted to know if there is somewhere she can get help with the surgery costs??? Any information would be helpful… Thank You!!!
CAROLYN EVANS
November 15,2020
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We are so sorry to hear your friend is going through all this. There are many organizations that can help. You can learn more here: https://prma-enhance.com/patient-support/
November 16,2020
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Tammy's Breast Reconstruction Journey. Part 2 - Finding My Surgeon
"Too Thin" For A DIEP Flap?
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
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 https://prma-enhance.com/schedule-your-consultation/
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
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: https://prma-enhance.com/cosmetic-surgery/breast-augmentation/. If you would like to schedule a consultation you can give us a call toll free at 800-692-5565
Yojana Bindu choudhary
I want to know about the cost of diep flap reconstruction surgery of breast. I’m Indian but my keen desire that come to prma plastic surgery center and reconstruct my breast so plz give me advice and help me. Thanks.
lovie g Fitzpatrick
I’ve had to different capsule of my breath where they have hardened. Now I have taken the implants out for 8 months and I have so much shrinkage on one and scar tissue on another that after seeing 3 plastic surgeon all said I need a reconstructive surgeon. Do you think I could be covered for this through my ins even thou it was caused by cosmetic surgery? Breast implants
PRMA Plastic Surgery
So sorry to hear you are going through all of this. Sadly, in most circumstances insurance will not cover the cost of additional surgery needed after implant complications for implants that were placed cosmetically.
May
Please I would like to have an estimate for unilateral DIEP delayed breast reconstruction surgery.
I am in Canada and my insurance will not pay if done outside my province and my country.
I am aware that each surgery is different but in general how much it cost approximately.
Thank you in advance,
PRMA Plastic Surgery
Thanks for reaching out May! You are correct that every surgery is different and as such it is difficult to give a proper cost estimate for a patient paying out of pocket. We would need to evaluate your needs and develop a personalized surgery plan before providing a cost estimate. We would be more than happy to schedule you a virtual consultation so you can meet with one of our board-certified plastic surgeons from the comfort of your home. You can fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
Veronica
I had double mastectomy and nipple removal and I’m looking what’s the cost for Diep flap and if it would be recommended.
I had cancer in my left breast. Lately I’ve started getting small fatty lumps and my left implant flip inside my breast. My breast are very uneven and I have consults with my doctors whom recommend me to have more fat transfer done
PRMA Plastic Surgery
Thanks for reaching out Veronica! We would be more than happy to evaluate your needs and provide you with our surgical recommendations along with a cost estimate based on your insurance patient responsibility requirements. We welcome you to fill out our virtual consultation for at https://prma-enhance.com/schedule-a-consultation/
Carolyn Evans
Hello I am writing today for my Sweet friend. She didn’t opt for a Masctomy when she was diognosed with her breast cancer. Then she found out that is she had done a Masctomy then her insurance would have paid or helped. It’s so sad you think you are doing the right thing because I cannot imagine how scary it would be to choose to have a Masctomy when the surgeon says otherwise. She is disfigured from all the surgery that was done. She told me a couple of weeks ago that she is Grateful to have survived the cancer and Radiation but she is Depressed because she is disfigured now. Her husband is cheating on her and this only added to her worthlessness… I just wanted to know if there is somewhere she can get help with the surgery costs??? Any information would be helpful… Thank You!!!
CAROLYN EVANS
PRMA Plastic Surgery
We are so sorry to hear your friend is going through all this. There are many organizations that can help. You can learn more here: https://prma-enhance.com/patient-support/