If you are considering a mastectomy or lumpectomy and thinking about reconstructive surgery, you may want to know about the initial and ongoing costs.
Since 1998, the law has required that most insurers who cover medically necessary mastectomies must also cover reconstructive surgery, including any surgery needed to obtain symmetry between your breasts. They are also required to cover treatment of any complications from the reconstructive surgery that your doctor considers medically necessary. Under the Affordable Care Act (ACA, or Obamacare), health insurance policies must cover hospitalization and surgical services, like medically necessary mastectomies. However, you will still be responsible for deductibles and co-payments, which can be substantial.
There are two major types of reconstructive surgery: implant reconstruction and tissue transfer (autologous) reconstruction. Experts recommend tissue transfer surgery when it is possible.
Reconstructive surgery with breast implants recreates your breast shape with a breast implant. Breast implants can either be filled with saline (salt water) or silicone gel (a synthetic material). All breast implants have an outer envelope made of silicone. This envelope can be “smooth” or “textured.” If you don’t have enough tissue available, your surgeon will place a tissue expander for a few weeks. Once the tissue is stretched enough, the expander will be replaced with an implant.
The cost of breast reconstructive surgery varies greatly, and most patients only pay a fraction of the total cost. Surgeons who live in certain geographic areas and those with more experience, often charge more for the surgery. If you choose reconstruction of both breasts, the surgery will be more expensive than for one breast. The surgery will also cost more if you get an implant in the other breast to make your breasts symmetrical, rather than just one implant. In addition, silicone gel-filled breast implants usually cost about $1,000 more than saline-filled implants. In addition to the thousands of dollars for the surgeon’s fee and for the implants, there will also many other costs related to the surgery, like fees for hospitalization, anesthesia, and imaging.
You can request an itemized bill before your reconstructive surgery to see the total costs and what you will be responsible for paying.
If you are considering implant reconstruction, you should be aware that the costs continue in the years after your reconstructive surgery. For example, you will need additional treatment and/or surgery if you experience complications from the implants, like infection, rupture, pain, or asymmetry. Women who undergo reconstructive surgery have higher complication rates than women who undergo breast augmentation. Some complications can only be fixed through another surgery, which is called a revision surgery. For example, a study conducted by a major implant manufacturer found that 46% of reconstruction patients needed additional surgery within the first 2-3 years after getting silicone gel-filled breast implants. Even if these surgeries are covered by insurance, you are still responsible for deductibles and co-pays.
The FDA recommends that women with silicone gel breast implants get an MRI to check for leakage 3 years after implantation and then every other year after that. Unfortunately, a breast MRI costs about $2,000 or more. Most insurance policies will not cover an MRI to check for implant leakage unless there are symptoms of a rupture, such as burning or changes in size or shape. That’s unfortunate, because you can avoid health and cosmetic problems if you remove ruptured or leaking implants before the leak is obvious. Even though it’s expensive, an MRI is the most accurate test to show if your silicone gel implants have ruptured, so that you can have them removed before they leak into your breasts and lymph nodes. If you are considering silicone gel breast implants, check to see if your insurance plan covers breast MRIs to regularly check for problems with your implants. You can read more about removing breast implants here and about the costs of revision and removal surgeries here.