If you are considering a mastectomy or lumpectomy and thinking about reconstructive surgery, you may want to know about the initial and ongoing costs.
The Women’s Health and Cancer Rights Act of 1998 is a law that requires that private insurance companies pay for breast reconstruction if they pay for mastectomies. This includes reconstruction on the removed breast, modification of the other breast to create a symmetric appearance, and treatment of any complications that result from a mastectomy or reconstruction. The forms of reconstruction covered may vary by state and insurance provider, so it is important that you call your insurance provider to see which options will be covered in your particular case. You will also still be responsible for deductibles and co-payments, which can be substantial.
There are two major types of reconstructive surgery: breast implant reconstruction and autologous tissue transfer reconstruction (also called Flap Procedures). Experts recommend tissue transfer surgery when it is possible. You can learn more about the types of reconstruction options here.
The cost of breast reconstructive surgery varies greatly, and most patients with health insurance 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.
You can request an itemized bill before your reconstructive surgery to see the total costs and what you will be responsible for paying.
Costs for Implant Based Reconstruction
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.
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 cosmetic 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. The Women’s Health and Cancer Rights Act requires that private insurance companies pay for any treatment of any complications that result from a mastectomy or reconstruction. However, even if these these revision surgeries are covered by insurance, you are still responsible for deductibles and co-pays.
Because most women don’t notice when a silicone gel implant ruptures, the FDA recommends having breast MRIs regularly to detect ruptures that have no symptoms. When silicone breast implants were first approved, the FDA recommended that all women undergo a breast MRI 3 years after getting breast implants, and every other year after that. However, because of the expense and the reluctance of plastic surgeons to encourage MRIs for silent ruptures, very few women followed the FDA’s advice. As of October 2020, FDA now recommends an MRI 5-6 years after the initial surgery and every 2-3 years 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.
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.