The attending physician and patient are to be consulted in determining the appropriate type of surgery. Coverage must include all stages of reconstruction of the diseased breast, procedures to restore and achieve symmetry on the opposite breast and the cost of prostheses and complications of mastectomy, including lymphedema. Penalize, reduce, or limit the reimbursement of an attending provider. Provide incentives to attending provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section. It is the position of ASPS that insurance policies that cover reconstructive surgery should provide coverage for conditions that result in abnormal structure to the breast.
Breast reconstruction is a functional procedure to restore a woman's normal body shape.
The timing of this surgery and the choice of surgical technique must be determined by the plastic surgeon, based on the patient's individual circumstances and reconstructive needs. Since breasts are paired organs, breast reconstruction includes surgery on the contralateral breast, if necessary, to achieve symmetry. Berger, K. And Bostwick, J. A Woman's Decision . Quality Medical Publishing, Inc, St. Louis, 1994. II breast deformities following conservative cancer surgery.