Breast Implant Removal

Removal of breast implants with capsulectomy/capsulotomy is medically necessary for implants placed for cosmetic augmentation, post-mastectomy reconstruction, or gender-affirming augmentation only when one or more of these are present: breast cancer requiring implant removal, BIA-ALCL, implant extrusion through the skin, or implants complicated by recurrent infections. Not covered/limited: removal of ruptured saline implants after prior cosmetic augmentation is not medically necessary, IgG testing for silicone implants is not covered, silicone implant removal for autoimmune disease is not covered unless one of the listed indications exists, autologous fat grafting after implant removal is cosmetic when the implant was cosmetic, and re‑insertion of implants after medically necessary removal is considered cosmetic.

"Removal of ruptured saline-filled breast implants is not medically necessary for members who have previously undergone cosmetic breast augmentation mammoplasty"