Options in Mammoplasty
(Breast Cosmetic Surgery)
- Breast Augmentation (Augmentation Mammoplasty)
- Breast Reduction
- Breast Reconstruction
- Breast Lifts (Mastopexy)
- Will Insurance Cover Cosmetic Surgery for the Breast?
- Questions to Ask Your Insurance Company
There are three general categories of mammoplasty (cosmetic surgery) performed on the breasts: augmentation , reduction and reconstruction.
Breast augmentation is performed to enhance the appearance, size and contour of a woman's breasts. Women consider breast augmentation for many different reasons. Some women feel their breasts are too small. Some desire augmentation after the breasts change after pregnancy. Others desire to correct an asymmetry in breast size.
Breast augmentation is performed with implants (see below) that can be placed under a chest muscle or over a chest muscle. The incision can be placed in the axilla (armpit), areola or lower breast fold. In general, all breast augmentations are minimally invasive procedures, involving incisions that are only three centimeters in length. For augmentations in which the incision is made in the armpit, an endoscope (thin tube with a small camera and light) may be used during the procedure.
Breast implants are made up of a silicone shell filled with either saline (a salt water solution) or silicone gel. A woman determines her desired size by fitting trial implants. Currently, saline filled implants are used on an unrestricted basis. Silicone gel filled implants are available only to women participating in approved studies and are not available for primary breast augmentation.
Breast augmentation is a relatively straightforward procedure. As with any surgery, some uncertainty and risk are associated with breast augmentation surgery. Know your concerns and expectations. Review the benefits, risks and alternatives. Seek consultation with a board certified plastic surgeon.
Breast reduction surgery is often used in women with large, heavy breasts who experience significant discomfort including neck pain, back pain numbness or weakness due to the weight of the breasts. During this procedure, excess skin, fat and breast tissue is removed.
After surgery, breast reduction can cause a change in breast sensation as well as the inability to breastfeed. In the case of large resections, which involve grafting of the nipple, however, almost everyone loses sensation and the ability to breastfeed. If breastfeeding is important to you, you may want to consider postponing a breast reduction procedure until you are done having children.
After breast reduction, most women report relief from the symptoms caused by having oversized breasts. For more on this topic, see the article on breast reduction surgery.
The procedure recreates a breast with the desired appearance, contour and volume. The nipple and areola also is recreated. Normal breast sensation and normal breast function, as with nursing, are not reconstructible when the sensory nerves or milk glands and ducts have been removed or significantly injured.
The appearance, contour and volume of the breast can be recreated with implants or with a woman's own tissue. If an implant is used, the implant is sized to match the opposite breast. When possible, the implant is placed beneath a chest muscle. A breast also can be recreated using a woman's own tissue. At times, a segment of the lower abdominal wall can be used. Other tissue options for autologous (using your own tissue) reconstruction use back muscle and skin or fat and muscle from the buttock.
Breast reconstruction can be done at any time after you have had a mastectomy. The procedure has no known effect on the recurrence of cancer and it does not appear to affect cancer surveillance. However, you will be instructed on self-examinations and scheduled for routine follow-up appointments for surveillance.
In some women, the skin is not strong or resilient enough to support the weight of the breast, causing the breasts to sag. With this condition, called ptosis, there is too much skin compared to breast tissue. To give the breast a lift, the excess skin must be removed. There are three surgical techniques generally used:
- Wise pattern. The incision, in the shape of an anchor, goes around the chest and below the breast.
- LeJeour. The incision goes around the areola and down.
- Donut or peri-areolar. The incision goes around the areola only.
Federal law requires that insurance covers breast reconstruction after a mastectomy performed to treat cancer. In the case of a cosmetic procedure, however, you should check with your insurance company for details, and talk with your doctor about associated costs.
It's important to know that if you've undergone breast implantation either as an aesthetic or a reconstructive procedure, your health insurance premiums may increase or your coverage may be dropped. In some cases, you may also be denied future coverage. If you experience complications from such procedures, most insurance companies will not provide coverage.
- Will my policy cover the costs of the surgery, the anesthesia, and/or other related hospital costs? (If the carrier only covers a percentage, make sure you know that figure. Additionally, write everything down, including the first and last names of the person answering your questions).
- Will there be an increase in my insurance premium?
- Will future coverage be affected?
IMAGES PROVIDED BY:
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care August 1, 2017
Previously edited by Charlotte E. Grayson , MD, September 2003.
Portions of this page from The Cleveland Clinic 2000-2003.