What plastic surgery procedures are covered by medical insurance?

When most people think of plastic surgery, cosmetic procedures such as a facelift or breast augmentation come first to mind. It is often forgotten that plastic surgery covers a wide range of different surgical procedures that repair, reconstruct or replace structures in many different parts of the body, such as face, trunk and hands. Many procedures performed by plastic surgeons actually have health, lifestyle, and psychological benefits that go far beyond aesthetics.

If you are considering having a plastic surgery procedure performed, it is natural to wonder what financial obligations you will have and whether or not a portion of the procedure could be covered by your medical insurance.

Whether or not a certain procedure is covered by insurance depends on several factors. Often, the deciding factor is whether the insurance company considers the procedure to be medically necessary. Purely cosmetic procedures, as for example facelifts, are not covered.

Some of the most common cosmetic procedures that have justifiable benefits for insurance coverage consideration include:

Breast reduction

Having large, heavy breasts makes many women feel uncomfortable both physically and psychologically. The excess weight of large breasts may cause back and neck pain, skin irritation, skeletal deformities, difficulty finding clothing, unbalance with activities. If an insurance company determines that the symptoms are enough to effect daily life and the procedure can be considered medically necessary, then it may be covered.

Breast reconstruction and fat grafting

For breast cancer patients who have undergone a mastectomy, breast reconstruction, including fat grafting may be covered by some insurance providers.

Eyelid surgery (blepharoplasty)

In cases where hanging or droopy eyelids cause visual impairment, it is possible an insurance company may cover eyelid surgery.


 Some patients may find very large labia physically uncomfortable and cause discomfort with underclothes, difficulty with maintaining hygiene during menstruation and pain during and after intercourse. Hence it is possible, for the insurance company to cover the surgery as medically necessary.

Excess skin removal

Excess skin after significant weight loss may pose enough of a problem that it is considered medically necessary to have it removed. When the skin hanging from the lower abdomen causes a patient to have repeated infections and painful rashes, a panniculectomy (excision of the excess skin on the lower abdomen may be covered by insurance

C-section scar revision

The C-section scar may be tethered, painful, deformed and cause a flap of skin to hang over it. Painful lesions called keloids might develop and continue to grow, affecting appearance and freedom of movement. In this case, you may be able to get insurance to cover a scar revision.

While the final decision on whether or not the procedure will be covered lies with the insurance provider, it is important to choose a specialist plastic surgeon. A specialist plastic surgeon will be able to determine whether or not you may be eligible to have your procedure covered by insurance. This will help the chances of getting the insurance company to consider the case.

Dr Mackenzie is an affiliated provider of the Southern Cross Health Society,  First Choice Provider for NIB and she closely works with other insurance providers such as AIA, Partners Life, Unimed and Accuro.