Breast Procedures - MEDICAID - SOUTH CAROLINA

Breast reconstruction services following mastectomy, lumpectomy (including prophylactic) or trauma (within 12 months) are covered, including autologous flap reconstruction, implants and tissue expanders, nipple/areola reconstruction and tattooing, revision surgery, and contralateral mastopexy/reduction/augmentation for symmetry. Coverage is contingent on medical necessity and patient suitability (age, body habitus, general health, planned cancer treatment), with symmetry or donor‑site procedures requiring clinical justification (some, e.g., reduction mammaplasty to preserve nipple viability, may need medical director review); capsulotomy/capsulectomy are limited to implant‑related contracture and elective cosmetic augmentation unrelated to mastectomy/trauma is not covered.

"Procedures on the opposite breast (mastopexy, reduction, augmentation) are performed for symmetry and are contingent on clinical justification."