What does Insurance Cover for Large (8cm) Benign Mass Removal?

Daisey4522

Hello. My name is Ginger and I am 28 years old. I have an 8 cm mass in my directly under the nipple of my right breast that was found to be benign. A couple of weeks ago I went to see a Breast Surgeon and she recommended that I have the mass removed immediately. The concerns are that the mass is very large, it seems to be growing, and is directly under the nipple so there is a chance that I could lose my nipple.

The breast surgeon said that the surgery will leave me deformed because of the mass size and location and that I will need to have reconstruction. I am currently a DD and she says that she is not sure about the cup size but that it will bring that breast down to a C. She recommends that I get a reduction in the left breast because symmetry is important to me. I saw a reconstruction surgeon she recommended that same day and she recommended that I get an implant in the right breast rather than reduction in the left. I do not know how I feel about having to deal with an implant for the rest of my life so I was leaning towards a reduction, but I also hate mess with the breast that does not have a mass. I know there are other options such as tissue implant too... I'm still trying to weigh my options.

Has your insurance paid for any reconstruction after mass removal of a benign mass? The mass is so large (8cm) so reconstruction is necessary. It is my understanding that if this was a malignant tumor insurance would cover the reconstruction, even reconstruction of the other breast to create symmetry, but I am not sure since this is a benign condition. The reconstruction surgeon said that they would not cover it. Have you had surgery on a benign mass? If so, can you tell me your experience (type of reconstruction & how much you had to pay)?

It is open enrollment this week so I am able to choose a new insurance for the surgery (I do not plan to have the surgery until January so it will be under a new insurance plan). I will contact my insurance once I decide what type of reconstruction I want to do, but I would like to know if there is any hope that they will cover the reconstruction.

I would be GREATLY appreciative to hear of your experiences.

Thank you!
Ginger

PS – I did some wonderful information on this website regarding "Paying for Reconstruction Procedures" but it's not clear to me if that is only for malignant cases or if that would go for benign breast surgeries (especially in my case since the mass is so large). http://www.breastcancer.org/treatment/surgery/reconstruction/paying-for