Breast reconstruction is a term that is used to describe a type of surgical procedure designed to reshape or replace the breast. It is sometimes used interchangeably with plastic or cosmetic surgery that is used to redefine the breast, but in many cases, breast reconstruction takes place after an injury to the breast that has destroyed tissue or after a mastectomy or similar procedure related to breast cancer. Reconstruction of the breast generally restores form to the breast, but currently, a reconstructed breast may not function in terms of breastfeeding; however, ongoing research and advancing technologies in cellular 3D printing may eventually change the outlook for patients who wish to breastfeed after reconstruction surgery.
How is Breast Reconstruction Performed?
A breast reconstruction procedure can be carried out during breast surgery involving a mastectomy or lumpectomy, but some patients will need months or longer to recover prior to receiving breast reconstruction surgery. The most common way to make a new breast or replace breast tissue is to graft tissue from another part of the body. Implants comprised of silicone gel may then be used to fill out the shape and size of the newly constructed breast.
Depending on the case, a surgeon can usually create a new breast that matches the size of a remaining breast and the body frame size of the woman for whom the surgery is being performed. Modern surgical techniques allow for breast reconstruction with minimal scarring or further damage to surrounding tissue.
Does Medicare Cover Breast Reconstruction?
Original Medicare coverage provides benefits for breast reconstruction in cases where the procedure is deemed medically necessary. In general, approved procedures will involve breast reconstruction after a mastectomy required for cancer treatment or after a serious injury to the breast that leaves the tissue severely depleted.
In some situations, Medicare recipients seeking out breast reconstruction surgery may need to finish certain treatments for things like cancer before coverage goes into effect for surgery. If a breast reconstruction surgery is anticipated prior to removal of breast tissue to treat cancer, Medicare recipients are encouraged to work with their surgeons and Medicare plan managers to ensure that all medical documentation has been submitted for a faster and more efficient approval process.
In terms of benefits, Medicare coverage for breast reconstruction is usually available under Medicare Part B. This part of Medicare covers outpatient surgery and doctor’s visits and will cover the actual surgery itself if it is performed in an outpatient setting. Medicare Part A is used for coverage while formally admitted to a hospital and may be billed if someone with Medicare insurance needs to recover in a hospital or skilled nursing facility after the surgery. Medicare Part D provides coverage for prescription medications and may help cover drugs prescribed during the recovery phase once released from care.
Medicare does not, however, cover cosmetic or elective surgeries that are not prescribed to treat a disease or preserve life. This applies not only to breast reconstruction, but also to any type of cosmetic surgery. As a result, preventive mastectomy operations may require some extra effort on the part of a Medicare recipient who has a family history of breast cancer to receive approval. In addition, Medicare does not provide coverage for breast augmentation when the purpose of the procedure is to improve one’s appearance, and the surgery will only cover reconstruction of the affected areas. This means that a surgeon can’t provide cosmetic surgery to an unaffected breast during the procedure and still have that part of the procedure covered by Medicare insurance.