Breast Implant Removal - (0048)

Cigna covers removal (with or without capsulectomy) of saline or silicone breast implants when performed for reconstruction after mastectomy/lumpectomy, confirmed silicone rupture/extrusion, interference with cancer diagnosis/treatment, infection unresponsive to medical management, exposed implant, Baker Stage IV contracture, tissue necrosis, BIA‑ALCL or BIA‑SCC, or current use of Allergan BIOCELL textured devices, and excludes removal solely for suspected autoimmune/connective tissue disease, cancer prevention, cosmetic or psychological reasons, implant shifting/migration, or isolated saline rupture without complications. Required documentation includes imaging confirmation for silicone rupture (mammogram/US or MRI), pathology/cytology for BIA‑ALCL/BIA‑SCC, evidence of failed medical therapy for infection, Baker grade for contracture, device history (e.g., Allergan BIOCELL), and records showing interference with cancer care or prior oncologic surgery.

"Removal of either a saline-filled OR silicone gel-filled breast implant when associated with breast reconstruction following mastectomy or lumpectomy is considered medically necessary for ANY indic..."