June 15, 2025

Is a Breast Lift Covered by Insurance? What You Need to Know

Sanam Zahedi, MD Plastic Surgeon

Category:Breast Lift

A breast lift can help restore breast shape and remove excess skin caused by aging, pregnancy, or significant weight loss. Many people consider a breast lift a cosmetic procedure. However, some cases may qualify as medically necessary, especially when sagging breasts cause physical discomfort or chronic pain. Is a Breast Lift Covered by Insurance? Not always—but in some cases, it is. It’s important to understand how insurance coverage works for a breast lift. Knowing what qualifies as a medical necessity and what documentation your insurance provider requires can help you get the procedure covered.

What is Breast Lift Surgery?

Breast lift surgery raises and reshapes sagging breasts. Results are achieved by removing excess skin and tightening the surrounding breast tissue. Your breast lift surgeon may also reposition the nipple to improve breast shape.

Most breast lifts are cosmetic; however, they can be medically necessary for some patients. Women who experience physical discomfort, such as shoulder pain, back pain, or skin irritation due to sagging, may be eligible for insurance coverage. Still, some insurance providers may cover a breast lift if there’s proof of medical necessity. The process often involves presenting documented physical symptoms and obtaining evaluations from a primary care physician or a board-certified plastic surgeon.

Sometimes, a breast lift is combined with a breast reduction or done as part of reconstructive surgery. These types of breast surgeries are likely to be covered by insurance companies, especially when they address pain or restore shape after illness or injury.

Those looking into having to undergo a breast lift should talk to their healthcare providers. They will be able to see if your specific medical history meets insurance requirements for coverage. Your provider can also guide you through the next steps in the process.

Details About the Breast Lift Procedure

This procedure may also reposition the nipple if needed. It does not significantly change breast size, but it can be combined with breast reduction or breast implants for different results.

The procedure involves advanced techniques that vary depending on your anatomy and personal needs. A board-certified plastic surgeon will assess your needs and recommend the most suitable breast lift options for your specific situation.

For a breast lift to be medically classified as necessary reconstructive surgery, it must meet specific criteria set by insurance companies. Every insurance provider and plan is sure to have different specific criteria that must be met before approving a claim for this procedure. Some insurance companies may cover a breast lift when it’s tied to medical concerns. You can contact your insurance company to learn more about the specific requirements.

Documentation will be important if you’re pursuing insurance approval for a medically necessary breast lift. Records, including photos, medical reports, and assessments from your plastic surgeon’s office, help establish medical necessity for insurance companies. Insurance companies won’t cover strictly cosmetic lifts, but they may approve procedures linked to reconstruction surgery, previous trauma, or pain relief. This is especially so when evaluations and recommendations from qualified professionals support those reasons.

What is The Difference Between a Breast Reduction vs Breast Lift Procedure

A reduction and a lift are both surgical procedures designed to reshape the breasts, but they address different needs. Breast lifting techniques focus on removing extra skin and tightening the surrounding tissue to raise the breasts. This option is often done for cosmetic reasons, such as improving contour or reversing sagging. Medically necessary cases may include when physical discomfort is present, such as skin irritation or posture issues.

A breast reduction is a procedure designed to decrease your breast’s overall size. Breast reductions are typically recommended for individuals with large breasts who are experiencing chronic back, neck, or shoulder pain. Health insurance companies are more likely to approve a reduction. Compiling strong documentation from your care team makes it possible to get partial or full coverage for breast-lifting procedures. Insurance approval is more likely when the surgery helps relieve symptoms and improves daily function. Certain insurance companies require evidence that the procedure addresses a specific health-related issue.

What to Expect at Your Breast Lift Surgery Consultation

Your consultation is the first step in determining whether the procedure is the right choice for you. A board-certified plastic surgeon will examine your breasts and review your goals. This can be to ascertain if insurance coverage is possible and recommend the procedures that will deliver the results you’re looking for.

If you’re hoping to have your insurance cover a breast procedure, you’ll also need to discuss physical symptoms such as pain, skin irritation, or functional issues caused by sagging during the consultation.

During your breast lift consultation, you will also be asked to share documentation from other healthcare providers, including your primary care physician, if available. Your surgeon may also take photographs and recommend additional steps to support an insurance claim.

Does Insurance Cover Breast Lift Surgery?

In most cases, a lift is considered to be cosmetic and not covered by any insurance companies. Many policies classify it as an elective procedure, particularly when the primary goal is to improve appearance.

However, there are some patients who have their procedure covered by insurance as it’s deemed medically necessary. In these cases, the procedure is being done due to physical issues such as back pain, shoulder grooves from bra straps, or chronic skin irritation. In any case, you’ll need clear documentation and medical history highlighting these issues and what other remediation steps have been taken. Your records should demonstrate that the procedure is required to alleviate symptoms. It’s important to contact your provider directly to ask about specific requirements and coverage options.

When is a Breast Lift Deemed Medically Necessary?

A lift medically qualifies as necessary when sagging or stretched tissue leads to ongoing physical problems. Common issues include chronic back or neck pain, rashes or infections under the breastfold, and discomfort that interferes with daily life.

Reports from your primary care doctor can help support your claim to help insurance cover a breast procedure. Photographic evidence and symptom history are required to demonstrate that the surgery isn’t just for cosmetic purposes but is essential for your well-being.

FAQs: Is a Breast Lift Covered by Insurance?

How Much Does a Breast Lift Cost?

The cost varies widely but typically ranges from $6,000 to $10,000, depending on the surgeon, location, and whether additional procedures are done.

What’s the Recovery Time of Breast Lift Surgery?

Most patients return to light activity within a week. Full recovery and final results can take several weeks to a few months.

Who is a Good Candidate for a Breast Lift or Breast Reduction?

Candidates for lift or reduction are generally in good health, have realistic expectations, and are experiencing sagging, discomfort, or pain due to breast size or shape.

Ready for Your Breast Lift Procedure Consultation?

Dr. Zahedi at Zahedi Plastic Surgery in Fort Lauderdale provides expert care for women experiencing discomfort from sagging or stretched tissue. Schedule your consultation today to determine if a lift is right for you.