Removing breast implants may be necessary if the implants are causing discomfort or pain, preventing treatment for other medical conditions, or if they are simply due to be removed or exchanged in the normal course of use. Medicare coverage for this surgery may be available under certain circumstances.

Why Remove Breast Implants?

Depending on the circumstances, this surgery may be elective or necessary. Several medical conditions or cosmetic needs can lead to breast implant removal.

These are the most common reasons for removal:

  • Cosmetic or aesthetic preferences.
  • Implant lifespan reaches its natural end.
  • Infection in or around breast tissue.
  • Damaged, collapsed or extruding implant.
  • Adverse reaction to silicone fluid in the breast capsule.
  • Pain or disfigurement of the breast capsule.
  • Interferes with the diagnosis or treatment of breast cancer.

Your healthcare professional may perform a series of diagnostic tests to determine the necessity of an implant removal surgery. In cases where there is an infection, you may also receive a prescription for antibiotics.

Risks Associated with Breast Implant Removal

Although serious or urgent medical conditions may require you to undergo breast implant removal, you may be vulnerable to certain risks during recovery and beyond. Your healthcare professional can help you assess the probability of these issues before the surgery. There may be follow-up procedures or medications prescribed to you to help manage those risks.

Surgical risks can include excessive bleeding, clotting, swelling and pain that persists throughout recovery. Infection or improper healing at the incision site may also increase pain, scarring, skin loss and delay recovery from breast implant removal. Loss of sensation or numbness may occur in and around the breast tissue.

Monitor your symptoms closely and alert your healthcare professional of any changes to your condition throughout recovery in order to prevent these symptoms from worsening. Discuss any allergies to medication or pre-existing medical conditions with your healthcare professional to minimize any risks or complications that could occur.

Medicare Coverage for Breast Implant Removal

Original Medicare Part A and Part B provide benefits that help cover the costs of hospital stays and outpatient services related to many surgeries. Surgery for breast implant removal may qualify as a covered medical procedure if the need for the surgery meets certain criteria.

In general, Medicare’s benefits apply to medically necessary treatment for covered conditions. If your breast implants must be removed because the outer shell has broken, there is an infection or it prevents treatment for breast cancer, it may qualify for Medicare coverage through Part A.

Most recipients receive Part A (Hospital Insurance) coverage premium-free. If you pay a premium for Part A, then this premium must be paid in order for Part A to cover the cost of services after your deductible has been met. If you attend outpatient services before or after surgery to help diagnose or monitor your condition, this would fall under Medicare Part B (Medical Insurance) coverage. You will be responsible for monthly premiums, copayments or coinsurance costs and the Part B deductible must be met. If you have purchased a Medigap, or Medicare Supplement, plan, it will help cover the costs that Original Medicare does not, such as deductibles, coinsurance and copayments.

Medicare Advantage plans are required to provide at least the same coverage as Original Medicare Part A and Part B, but many offer additional benefits, such as prescription drug coverage. If you have a Medicare Advantage plan will prescription drug coverage, or if you have Original Medicare and have enrolled in a stand alone Prescription Drug Plan (PDP), your coverage may help pay for certain prescription medications your physician may order for your post-operative care.

Related articles:

What is Medicare Parts A & B

What is Medigap?