Breast Cancer Reconstructive Surgery

Breast reconstruction surgery is covered when performed after a medically necessary mastectomy or to achieve or restore symmetry after a medically necessary mastectomy.

In addition to coverage of prosthetic devices and reconstructive surgery for the diseased breast on which the mastectomy was performed, prosthetic devices and reconstructive surgery for the healthy breast is also covered when necessary to achieve a normal, symmetrical appearance.

A subsequent request for additional surgery to change the previously achieved symmetry is considered cosmetic unless the subsequent surgery is medically necessary or is being performed again to achieve symmetry after subsequent surgery has been performed on the diseased breast. Such cosmetic surgery is not a covered benefit.