Mastopexy

This policy addresses mastopexy (breast lift), including concurrent saline implant placement and revisionary mastopexy when performed for reconstructive purposes, contralateral symmetry, or to correct documented functional impairment. It covers breast ptosis due to aging, pregnancy, weight loss, postpartum atrophy (Grades I–III) and pseudoptosis, but excludes mastopexy performed solely for cosmetic/aesthetic reasons, is subject to the member’s benefit contract (contract language prevails), and notes substantially higher complication risk in previously irradiated breasts.

"Breast ptosis due to loss of dermal elasticity from aging."

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