Is mastectomy covered by health insurance?

Mastectomy is a surgical procedure in which the breast or breasts are removed, typically as a result of breast cancer or other severe health issues. Many women opt for breast reconstruction surgery after the procedure to restore the shape of the breast.

A common concern is whether or not insurance will cover the procedure. Fortunately, there are a number of insurance policies that include coverage for breast reconstruction following mastectomy. But this coverage and the process can vary between policies. To make the process easier and less stressful, it is important to know your rights and understand your insurance plan.

This article provides an overview of breast reconstruction, insurance coverage, and how you can obtain financial assistance for breast reconstruction.

What Is Breast Reconstruction?

Breast reconstruction surgery aims to create the appearance and shape of a breast that has been removed by a mastectomy. For some women, the decision to undergo reconstruction is made to make them feel more comfortable and confident after cancer treatment.

• Immediate reconstruction – done during the same surgery as the mastectomy.


• Delayed Reconstruction – months or years after the construction.

In addition, there are various approaches to reconstruction:

• Implant Reconstruction: This technique is performed with silicone or saline implants to create the shape of the breast. One of the most popular choices is typically a shorter surgery.


• Flap Reconstruction: This involves removing tissue from another area of the body, such as the stomach, back, or thighs. It is made from your own tissue, so the breast will feel more natural.

Does Insurance Cover Breast Reconstruction?

There are no laws in India that are dedicated to breast reconstruction coverage. But a lot of health insurance companies will cover reconstructive surgery as a cancer treatment benefit. Coverage will depend on the policy terms and the insurance company. It is advised to consult with your insurance provider before planning surgery.

What Is Usually Covered?

There are insurance plans available that will help cover the cost of rebuilding, and they typically cover:

• The cost of surgery for an implant or flap surgery.


• Hospital charges


• Breast reconstruction of nipples and areolas.


• Surgery on the other breast to balance or symmetrise the look of the breast


• Follow-up surgeries or corrections in case of complications

What May Not Be Covered?

Certain therapies or treatments may not be covered by insurance. These can include:

• Cosmetic surgery, but not related to mastectomy recovery


• Treatments that have not been proven in practice; experimental.


• Surgical cosmetic procedures (excluding medically necessary procedures)

How to Make Sure Your Insurance Covers Reconstruction

Follow these steps to make sure your insurance covers reconstructions:

• Read Your Insurance Policy Carefully. Check the documents of your policies or call your insurance company. Ask questions about coverage limits, waiting periods, and required documents.

• Get a Medical Recommendation. A medical necessity letter from your surgeon or oncologist should be helpful to support your claim if you need reconstruction.

• Store All Medical Records. Keep all reports, bills, prescriptions, and communication with the insurance company. These records are helpful in the event of delays or claims.

• Appeal if Your Claim is Rejected. Don't give up if your insurance claim is denied. There may be other medical records or doctors' recommendations that can be submitted to support the case. However, once this happens, it is time to look for Government or NGO Support.