Coverage for reconstructive breast surgery is provided for individuals undergoing covered prophylactic mastectomies. Prophylactic mastectomy for any other reason is considered not medically necessary.

How much does a prophylactic mastectomy cost?

Results: Lifetime prophylactic mastectomy costs were lower than surveillance costs, $1292 to $1993 lower for contralateral prophylactic mastectomy and $15,668 to $21,342 lower for bilateral prophylactic mastectomy, depending on the reconstruction.

How do you qualify for a prophylactic mastectomy?

You may consider prophylactic mastectomy if you have:

1. Already had cancer in one breast.
2. A family history of breast cancer.
3. Positive results from gene testing.
4. Radiation therapy.

Does Medicaid cover prophylactic mastectomy?

Coverage for a prophylactic (preventative) mastectomy is not guaranteed by Medicare. However, it might be covered under your state’s Medicaid program. Surgery for cosmetic reasons is not covered by Medicare.

What is the recovery time for prophylactic mastectomy?

The recovery time from a double mastectomy can vary from person to person, but it typically takes 4 to 6 weeks. Some surgeries involve removing the breast tissue but saving the nipple, while others remove the whole breast. More radical mastectomies also remove chest muscle and, rarely, the lymph nodes.

How much does a full mastectomy cost?

How Much Does a Mastectomy Cost? On MDsave, the cost of a Mastectomy ranges from $6,136 to $13,789. Those on high deductible health plans or without insurance can save when they buy their procedure upfront through MDsave. Read more about how MDsave works.

How long does a prophylactic mastectomy take?

A mastectomy without reconstruction usually takes one to three hours. The surgery is often done as an outpatient procedure, and most people go home on the same day of the operation.

How much does an elective mastectomy cost?

For patients not covered by health insurance, a mastectomy typically costs more than $15,000-$55,000 , not including breast reconstruction.

What happens if I test positive for BRCA?

A positive test result means that you have a mutation in one of the breast cancer genes, BRCA1 or BRCA2, and therefore a much higher risk of developing breast cancer or ovarian cancer compared with someone who doesn’t have the mutation. But a positive result doesn’t mean you’re certain to develop cancer.

Do you have to have insurance for a mastectomy?

If you have breast cancer OR a significant family history of breast cancer, then by law all insurance companies are required to cover whatever cancer surgery you need (i.e. lumpectomy or mastectomy), AND the breast reconstruction option of your choice.

Can you have breast reconstruction after a prophylactic mastectomy?

If you choose to have a prophylactic mastectomy, you may wish to have breast reconstruction. This may be done at the same time as the mastectomy or at a later time. Talk with a plastic surgeon about your reconstruction options. No federal laws require insurance companies to cover prophylactic mastectomy.

Do you have to have insurance for breast reconstruction?

A: Mastectomy and breast reconstruction is covered BY LAW by all insurance companies. If you have breast cancer OR a significant family history of breast cancer, then by law all insurance companies are required to cover whatever cancer surgery you need (i.e. lumpectomy or mastectomy), AND the breast reconstruction option of your choice.

Who is the best doctor to see for a prophylactic mastectomy?

Paul S. GIll, M.D. Your medical insurance should cover the cost of bilateral prophylactic mastectomy and breast reconstruction if you meet of the medical criteria. You should see a breast oncologic surgeon and Plastic surgeon to help you with this situation. This is not a battle to fight by yourself.