What Types of Breast Augmentation Procedures are Covered By Insurance?

By: Dr. Sean Kelishadi, M.D. FACS


Feeling comfortable in how you look can be a big boost to your self-esteem. In some cases, surgery such as breast augmentation or breast reduction not only helps women feel better about their appearance, but also correct issues affecting their quality of life. But what kinds of breast surgeries are covered by insurance? At SSK Plastic Surgery, board-certified plastic surgeon Dr. Sean Kelishadi guides patients through the process. To determine if your desired procedure will be covered, we encourage you to reach out to our clinic for a consultation about plastic surgery and insurance in Newport Beach, CA.

Plastic surgery and insurance

Who pays for plastic surgery depends on a number of factors. When you come in for a consultation, Dr. Kelishadi and his staff can review your case and tell you what you need to know about the insurance process. Keep in mind that medical insurance does not necessarily pay for the entire procedure. Patients may still be responsible for deductibles and copays as outlined in their health insurance plan, so learn how much you may pay out of pocket in Newport Beach.

Most insurance companies base their decision on whether a surgery is considered cosmetic or reconstructive. Reconstructive surgery is performed when a patient has suffered from previous trauma or genetic defects. Cosmetic procedures enhance and reshape certain parts of the body to improve appearance. No matter which category you fall into, it is important to speak with a physician who has knowledge and experience in this area. Dr. Kelishadi can assess your condition and help by coordinating with your insurance company.

While the process varies based on the insurance provider, anyone interested in having plastic surgery will have to give their provider a letter of medical necessity, stating that the procedure is required to resolve an underlying health problem. More than that, most carriers request 6 – 12 months of medical documentation from professionals such as a physical therapist or chiropractor to ensure other procedures have been ruled out before approving surgery. Procedures such as breast lift, breast augmentation, and breast reduction may be covered.

Breast augmentation or reconstruction

We understand that having breast cancer can be difficult and overwhelming. When faced with this diagnosis, patients do have options about how to build up or reconstruct their breasts following the removal of cancer. Dr. Kelishadi can help women who desire breast reconstruction after mastectomy so they can look more proportionate and feel more complete. During your appointment, we will spend time getting to know your situation, then devise a breast surgery that best suits your needs. If breast implants are chosen, we use proven techniques and tools to provide a natural look and feel. SSK Plastic Surgery performs countless augmentation and reconstruction procedures with breast implants every year, which are often covered by health insurance.

Breast reduction and lift

Breast reduction surgery, also called reduction mammoplasty, is available to women who have excess breast tissue to reduce breast size. Women with large or very heavy breasts may have physical limitations, such as poor posture, which leads to neck and shoulder pain. Fortunately, breast reduction may be covered by health insurance based on your provider and insurance plan. A breast lift may also be performed at the same time to prevent sagging or drooping breasts. For patients considering breast reduction in Newport Beach, CA, it is important to examine their coverage material before scheduling surgery. Here’s what you can do to see if this procedure could be covered or partially covered to alleviate your symptoms:

  • Call your insurance provider and see whether a pre-authorization letter is required for breast reduction surgery

  • See if your insurance company needs a medical exam or a second opinion by another general physician

  • Learn if you need to use an in-network surgeon in order to be covered

Learn more about breast augmentation cost

Many women think about changing their breast size but are concerned about plastic surgery and insurance. If you feel you are a candidate for breast surgery and would like to learn more about insurance coverage, contact Dr. Sean Kelishadi at SSK Plastic Surgery. During a consultation, we can listen to your goals and offer you a baseline of information to get the process started. Each insurance company has different limitations for coverage, so don’t be discouraged by the process. Learn about procedures that involve breast implants, breast lift, and breast reduction by reaching out to our professionals in Newport Beach, CA for a consultation.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.