Breast Implant Removal
DESCRIPTION
Breast implantation surgery is performed for cosmetic breast augmentation, breast reconstructive surgery following mastectomy, replacement of implants, or augmentation/reconstruction of congenital defects or anomalies. There are currently only two types of breast implants. Saline breast implants consist of a silicone elastomer rubber-like shell filled with medical grade saline. Silicone-gel implants are made of an inner transparent silicone center surrounded by a silicone elastomer envelope. Some silicone-gel implants have a second fluorosilicone barrier to reduce the chance of leakage. Studies have indicated that intact silicone breast implants do not increase the risk of connective tissue disease or autoimmune disease.
POLICY
Removal of breast implant(s) for documented leakage from a silicone-gel breast implant is considered medically necessary. (See note under ADDITIONAL INFORMATION.)
Reconstruction following removal of a leaking silicone-gel breast implant will be considered medically necessary if the original procedure was considered a medically necessary and appropriate reconstructive surgical procedure (i.e., breast reconstruction following mastectomy).
If the original implant was considered a medically necessary and appropriate reconstructive surgical procedure, a capsulectomy is considered medically necessary as a part of implant removal and reconstruction.
Removal of breast implant(s) for documented leakage from a saline breast implant done for cosmetic purposes is considered cosmetic. (See note under ADDITIONAL INFORMATION.)
Reconstruction following a removal of a leaking breast implant originally placed for cosmetic purposes is considered cosmetic.
Since intact silicone breast implants pose no health risk, removal of an intact implant is considered cosmetic.
See also:
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Documentation/verification of leakage of a silicone-gel breast implant must be performed by magnetic resonance imaging (MRI), mammogram, or ultrasound.
Documentation/verification of a leaking saline breast implant is by observation of loss of size or shape of the breast in a short period of time.
In accordance with State and Federal mandates, removal and replacement of a leaking saline implant would be appropriate if the original surgery was a result of a mastectomy (not including lumpectomy). The surgery on the non-diseased breast to establish symmetry between the two breasts in a manner chosen by the patient and the physician would also be appropriate according to State and Federal mandates.
SOURCES
American Society of Plastic Surgeons. (2005, March). Treatment principles of silicone breast implants. Retrieved March 30, 2007 from: http://www.plasticsurgery.org/medical_professionals/health_policy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=18812.
BlueCross BlueShield Association, Medical Policy Reference Manual. (2:2003). Reconstructive breast surgery / management of breast implants. (7.01.22). Retrieved March 29, 2007 from BlueWeb.
Breast Implant Safety. (2007). What is saline? Retrieved May 8, 2007 from http://www.breastimplantsafety.org/ImplantOptions/whatissaline.php.
Breastcancer.org. (2007). Breast implants. Retrieved May 8, 2007 from http://www.breastcancer.org/bey_tre_recon_Implnt.html.
Brown, S. L., Silverman, B. G., & Berg, W. A.. (1997). Rupture of silicone-gel breast implants: causes, sequelae, and diagnosis. Lancet, 350 (11),1531-37.
Janowsky, E. C., Kupper, L. L., & Hulka, B. S. (2000). Meta-analysis of the relation between silicone breast implants and the risk of connective-tissue diseases. The New England Journal of Medicine, 342 (11), 781-90.
LexisNexis.™ Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 25 Mandated Insurer or Plan Options: 56-7-2507. Reconstructive breast surgery. Retrieved July 19, 2002 from http://198.187.128.12/tennessee/lpext.dll?f=templates&fn=fs-main.htm&2.0.
National Research Center for Women & Families. (2007). If your breast implant breaks. Retrieved May 8, 2007 from http://www.breastimplaninfo.org/what_know/if_implant_breaks.html.
Rockwell W. B., Casey, H.D., & Cheng, C. A. (1998). Breast capsule persistence after breast implant removal. Plastic and Reconstructive Surgery, 101 (4), 1085-1088. Abstract retrieved March 30, 2007 from PubMed database.
Townsend, C.M., Beauchamp, R. D., Evers, B. M., & Mattox, K. L. (Eds.). Townsend: Sabiston Textbook of Surgery (17th ed., pp. 934-936 and 2194-2195). Philadelphia: Saunders, An Imprint of Elsevier.
U. S. Department of Labor. (2006). Your rights after a mastectomy (WHCRA). Retrieved March 30, 2007 from: http://www.dol.gov/ebsa/publications/whcra.html.
U. S. Food and Drug Administration. (2004, July). Breast implants: potential local complications and reoperations. Retrieved April 26, 2007 from: http://www.fda.gov/cdrh/breastimplants/breast_implants_risks_brochure.html.
U. S. Food and Drug Administration. (2004, June). FDA breast implant consumer handbook 2004. Retrieved March 30, 2007 from: http://www.fda.gov/cdrh/breastimplants/indexbip.PDF.
U. S. Food and Drug Administration. (2004, September-October). Making an informed decision about breast implants. Retrieved April 26, 2007 from: http://fda.gov/fdac/features/2004/504_implants.html.
U. S. Food and Drug Administration. (2006, November). FDA approves silicone gel-filled breast implants after in-depth evaluation. Retrieved March 30, 2007 from: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01512.html.
Young, V. L. (1998). Guidelines and indications for breast implant capsulectomy. Plastic and Reconstructive Surgery, 102 (3), 884-894.
ORIGINAL EFFECTIVE DATE: 11/1989
MOST RECENT REVIEW DATE: 11/10/2007
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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