American Society of Plastic Surgeons
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ToniaHite
7 months ago
Answered

what should I do

When I started developing breast only one side developed... This has affected my life in so many ways. My self esteem, things I wear and activities I like to do in the summer that I just try to avoid. I've seen a few doctors and at first thought it would cost about $4500. I got insurance through work and tried to get it covered that way and didn't happen but that Dr. told me about $10,000.

Procedure: Breast Reconstruction
Type: Question

Replies 7

Debra Johnson
ASPS Surgeon
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Most women's breasts are different from each other: sizes, nipple position/size, degrees of droopiness. I assume you're an adult. Have you had children? Sometimes insurance will cover if there is a large difference between the two breasts, particularly with neck, back, or shoulder pain. You could have the larger breast reduced to match the smaller, the simplest solution. You could have an implant in the smaller to match the larger, also relatively simple but harder to get insurance companies to pay for an implant in a non-cancer patient. Or you could operate on both breasts to try and get the closest size and shape symmetry. You should discuss this issue with a case manager at your insurance company and convince her of your need for surgery. A squeaky wheel often can get what they need. If they persist in saying the surgery is "cosmetic" then you'll have to save and pay for it yourself.

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Tracy McCall
ASPS Surgeon

You are not the only person with this problem. Sometimes insurance will cover it and sometimes they won't. I wish they would cover it, as it really is a congenital deformity, and for all the reasons you listed. If you have already submitted this through your insurance and been turned down, you have the option to do it as a self pay procedure. $4500 is probably a little cheap for this. One great way to address this would be to find a plastic surgery residency program, which would offer surgery at a lower price than a private office. They have resident clinics where you can get discounted cosmetic/self pay surgery. The residents are overseen by professors of plastic surgery, so don't worry about the fact that you are working with doctors in training. There is a residency program in Louisville.

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Gregory Sexton
ASPS Surgeon

I think you should shop around. Find 2-3 surgeons you feel comfortable with, and get an estimate from each. If there is no sagging on the larger side, then a bilateral augmentation is all you need, $4000 to $6000. If the larger side is sagging, then a lift on one side and augmentation on the other, $6000-$7000.

Good luck,

Greg Sexton, M.D.

Columbia, S.C.

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Daniel Hatef
ASPS Surgeon

Hi Tonia, it sounds like you either have something called Amazia or something called Poland's Syndrome. In my experience, it has been exceedingly difficult to get these covered. Anymore, insurance companies are even using sketchy techniques to avoid covering breast reconstruction after cancer, in violation of federal law. The doctor who quoted you $10,000 may have been planning a 2 stage process, in which case I think that's actually a very good price. As is $4,500 for a 1 stage procedure. In my hands, doing this in 2 stages would probably approach $15,000; $7,500 for 1 stage. You should find out who is overseeing your case at the insurance company level and if this is a congenital deformity, insist that they pay for it. Maybe with luck and persistence they will approve it. There is also patient financing through CareCredit and a number of other companies. This is a tough situation, good luck in your journey!

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McKay McKinnon
ASPS Surgeon

Asymmetrical breasts can be corrected, as you already have heard. I think it is usually best for symmetry to augment the undeveloped breast and reduce the "overdeveloped" breast, with or without a mastopexy.

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McKay McKinnon
ASPS Surgeon

You could consider augmentation of the undeveloped breast and reduction/mastopexy of the "overdeveloped" breast for best symmetry in most cases. The cost should be well below the $10,000 quote you received.

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