Does Insurance Cover Breast Implant Removal

Patients with breast implants seldom want them removed. But from time to time, an issue arises that necessitates breast implant explant surgery (implant removal).

Some patients want their implants removed because they were unhappy with their breast augmentation results to begin with. Others desire a change after a few years have passed and simply want new implants swapped for the old ones. Still other patients need explant surgery because of a medical and/or comfort concern, like a rupture or capsular contracture .

Whether it’s for aesthetic reasons or medical concerns, patients often have one pressing question when we first meet with them for an implant removal consultation: Does insurance cover breast implant removal?

Table of Contents

Insurance and Cosmetic Surgery Procedures

The question of whether an insurance company will pay for cosmetic surgery procedures is a common one. Patients always want to know if their plan will cover procedures such as liposuction, tummy tuck surgery, breast augmentation, or rhinoplasty.

In the end, the best sub-question to ask yourself is: “Is my surgery medically necessary?” Because, ultimately, this is what insurance companies will be asking your plastic surgeon as well as their own doctors.

“Medically necessary” is insurance company speak for “likely covered”. When a procedure is medically necessary, it usually means it is compulsory that the insurance company pays for at least part of it. The actual definition of this term is a little harder to define, but we’ll do our best.

Basically, when a procedure is medically necessary, this means that a certified doctor believes it:

Is necessary according to generally accepted medical standards
Is not investigational or experimental in nature
Is consistent with a legitimate medical diagnosis and the accompanying symptoms
Is not being performed for aesthetic purposes or convenience
Can be provided safely and with effective results

When contemplating the question does insurance cover breast implant removal Blue Cross Blue Shield often has high quality answers. According to one of their pages, “Determining the medical necessity and coverage of removal requires documentation of the type of implant and whether it was used for reconstructive, restorative or cosmetic indications.” This means that not only should your surgery be medically necessary, but it must also be documented as medically necessary.

Is Breast Implant Explant Surgery Considered Medically Necessary?

Let’s get back to the focus of this article: whether health insurance companies will cover breast implant removal.

If the above sounds a bit confusing, you’re not alone. Many people find health insurance language hard to understand, which is why you should contact your insurance company directly if you have questions about getting your implants removed. This is ultimately the only way to know for sure whether your surgery will be covered.

Does Health Insurance Cover Breast Implant Removal?

Essentially, whether or not this procedure will be considered medically necessary by your insurance company depends on why you want the surgery in the first place. Then again, it’s not as cut and dry as this. For instance, if you have been experiencing capsular contracture, (which can cause discomfort and a distorted shape to the breasts), insurance will sometimes cover implant removal … and sometimes not.

Light capsular contracture (usually Grade 1 or 2) is generally considered to be too insignificant to require surgery. Painful capsular contracture with lots of scar tissue, on the other hand, may be covered.

If you are interested in getting your implants removed because you simply no longer like them (or like the look of them), then the procedure will almost certainly not be covered by most insurance companies. For health insurance to pay for a plastic surgery procedure, the issue (cause of the surgery) must be pressing and not convenient. An implant rupture or breast cancer, for example, may result in complete or partial coverage of breast implant removal surgery.

What Are the Most Common Reasons for Removing Breast Implants?

Both saline and silicone breast implants should last around ten years, according to most experts — sometimes, longer. Although many patients will wait this entire time before swapping theirs out, other patients might decide to have their implants removed sooner rather than later.

Here are the top reasons patients might choose to have their breast implants removed:

Capsular contracture
Painful implants
Too much scar tissue
Rippling
Implant exchange
Rotating (shifting) implants
Infection
Rupture or leaks
Breast cancer

How Much Will Breast Implant Removal Cost?

This depends. The cost of your procedure will, first of all, largely depend upon the breast implant removal method you choose. For instance, a breast implant explant surgery with breast lift will cost more than an implant explant surgery alone. In the end, the extent and scope of your procedure will determine your cost.

Other factors that will contribute to the cost of your procedure include:

The geographical location of your surgery
The experience and skill of your surgeon (their particular surgeon’s fee)
Anesthesia-related costs
Surgical facility (or hospital) costs
Additional costs for labs, medical exams, compression garments, medications, etc.

What should you consider when planning your post-explant journey?

Your post-explant journey offers multiple pathways depending on your goals: if you want to maintain volume, consider replacement implants or natural fat transfer; if you’re focused on improving shape and contour, a breast lift or reduction can address skin changes; or if you prefer simplicity, removal alone lets you see your natural result first.

The key is understanding whether you’re prioritizing volume restoration, shape enhancement, or taking time to decide your next step.

Book a Consultation Today

If you are interested in breast implant removal, we first suggest looking some breast explant before and after photos. Then, please give our office a call to schedule your initial consultation with female board-certified plastic surgeon Dr. Ashley Steinberg. Breast implant explant surgery is sometimes a time-sensitive procedure, so please call us at your earliest convenience if this is the case for you.