Question:
I had a bilateral mastectomy in 2004 with tram flap reconstruction, developed fat necrosis, which lead to silicone implants. Is there a high risk of leakage/failure of the implant after so many years? If the implants should be replaced, will insurance cover the procedure?
Answer:
In general, if you have had a mastectomy then your insurance should cover the replacement of the implants if there is established medical necessity to do so. If you’d like to let me know what insurance you have, I can send you their specific policy for you to review. Within that policy, it should clearly state what would establish medical necessity. The most common reasons are failure of the device or problems resulting from the implants like severe capsular contracture. Although implants are not lifetime devices, if there is no proven rupture and you are not having problems, there is no need for replacement. An MRI or ultrasound would be the study to request to see if a rupture might be present. One caveat to that would be if the device you have has been recalled by the manufacturer, then it would be in your best interest to replace them.
