Breast surgery means different things to different women. For some, it’s a step toward relief from chronic back and neck pain. For others, it’s part of healing after a mastectomy or addressing changes that came with age or pregnancy. 

At Western Surgical Care in Lone Tree, we understand how personal this decision can be and how important it is to understand your insurance options before proceeding. 

Understanding what your insurance may cover takes a lot of the guesswork—and stress—out of the process so you can focus on feeling better and making the right choice.

Which Breast Surgeries Are Typically Covered by Insurance?

Not all breast surgeries are considered cosmetic. Many are medically necessary, and insurance providers often recognize that.

Procedures often covered by insurance include:

  • Breast reduction surgery when it’s tied to chronic pain, skin irritation, or posture issues
  • Mastectomy and breast reconstruction following breast cancer treatment
  • Surgery to correct asymmetry caused by prior procedures or trauma
  • Removal of breast implants if related to medical complications

Insurance companies typically require detailed documentation to apply for coverage. This can include your medical history, physical exam notes, and a record of attempted non-surgical treatments, like physical therapy or pain management. Your care team at Western Surgical Care can help gather and submit everything needed.

Getting Insurance Approval for Breast Reduction

Insurance approval may take time, but it’s possible with the right support.

For breast reduction surgery, insurers often ask for:

  • Records of chronic symptoms like back or shoulder pain
  • Evidence that symptoms haven’t improved with non-surgical treatment
  • Photos and measurements that demonstrate the medical need
  • A surgical plan with estimated tissue removal

When it comes to mastectomy or breast reconstruction, federal law offers important protections. Under the Women’s Health and Cancer Rights Act, most insurance plans that cover mastectomies must also cover reconstruction, including procedures for symmetry.

Our team, with the expertise of our Lone Tree General Surgeon, will guide you through each step and help advocate for your approval.

Understanding Out-of-Pocket Costs and Insurance Coverage

Even with insurance, you may still be responsible for some costs, such as deductibles or co-insurance. Before anything is scheduled, we’ll walk you through what’s covered and your potential out-of-pocket expenses.

If you’re uninsured or pursuing a cosmetic procedure, we offer support through insurance coverage and financing options. We’re happy to help you find a plan that works for you.

What If Your Procedure Isn’t Covered?

Some surgeries are considered elective, including breast augmentation or implant removal, for non-medical reasons. These procedures typically fall outside of insurance coverage.

In those cases, you’ll receive a detailed quote for your treatment. We’ll review each aspect of your plan and explore flexible payment options that fit your needs.

Ready to Take the Next Step?

Navigating breast surgery and insurance decisions doesn’t have to feel overwhelming. At Western Surgical Care, our team is here to guide you with transparency and compassion. 

Have questions about your insurance or whether you qualify for coverage? Contact Our Surgical Offices in Lone Tree to schedule a consultation and get clear answers from an experienced team.