When Is a Breast Lift Medically Necessary?

Breast lift (mastopexy) is one of the most common plastic surgery procedures in the U.S. Many women think about getting it at some point, whether for aesthetic reasons or because of changes to the breasts that have occurred over time. While breast lift is often considered a cosmetic procedure, there can also be medical reasons for doing it.

Medical Conditions That Require a Breast Lift

Significant Breast Ptosis (Sagging)

Ptosis refers to sagging or drooping of the breasts. It is a natural part of the aging process as skin loses its elasticity and breast tissue becomes less voluminous. However, in some cases, ptosis can become significant enough to cause physical symptoms. Indications that a mastopexy may be medically warranted include:
This can cause tension, shoulder grooving from bra straps, and irritation under the breast. In severe cases, the nipple may hang at or below the abdominal area, causing skin inflammation.
In addition to discomfort, loose skin increases the risk of irritation and infection in the folds. Overly stretched skin may also cause ulceration, which can be difficult to heal.
Due to this condition, women may develop poor postures over time, which can lead to chronic pain, spine disorders, and impaired breathing.
Patients with sagging breasts may experience difficulties in exercising and finding properly fitted clothing. Such interference must be severe for them to be eligible for insurance-covered surgery.
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Pencil Test

The pencil test is a simple at-home method you can use to check for breast ptosis or sagging. Place a pencil under your breast at the crease where the breast meets the chest. If the nipple is positioned above the pencil, this suggests good breast support. If it is not, there are three grades of ptosis:
Mild — nipples are in line with the breast crease (pencil)
Moderate — nipples are 1-3 cm (nearly 0.5-1 inches) below the crease
Severe — nipples are more than 3 cm (1.2 inches) below the crease
Patients with severe ptosis can schedule a consultation with our experienced surgeons at Exert Clinic regarding a breast lift. It may be crucial for long-term health and risk prevention.
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Gigantomastia (Oversized Breasts)

A breast lift is also medically indicated in cases of breast reduction surgery for gigantomastia. Due to the extreme stretching from massive breast weight, women are often left with excess skin after having a significant amount of breast tissue removed. By combining reduction techniques with a lift, the plastic surgeon can tighten and reshape loose skin for better support and eliminate folds that can cause rashes and infection. A breast lift may also help to correct posture and improve mobility.

Severe Asymmetry Between Breasts

Severe asymmetry between a woman’s left and right breast can cause physical pain, emotional distress, and hardships in finding properly fitted bras. In these cases, breast lift procedures may be deemed medically necessary to reshape the breasts. Mastopexy can provide significant relief of symptoms. It is often combined with breast augmentation or reduction to improve symmetry.
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Changes After Massive Weight Loss

Significant weight loss can lead to excess, stretched-out skin in the breast area. This loose skin can cause the breasts to appear deflated and saggy. Additionally, the areolas may become enlarged. For women who have lost 50+ pounds, these changes can cause physical discomfort, such as shoulder grooving from bra straps, skin irritation, infections under the breasts, and difficulty finding bras. In cases where conservative treatments (like specialized garments and topicals) have not helped with symptoms, a breast lift may be required.
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Congenital Defect or Deformity of the Breast

One medical condition that may necessitate mastopexy is a congenital defect or deformity of the breast. Some women are born with abnormalities, such as tubular breasts, asymmetric breasts, or Poland’s syndrome (a condition characterized by deformed or absent breast tissue). In these cases, breast lift procedures help to reshape them into a more normal proportion and appearance.

Can Insurance Cover a Medically Necessary Breast Lift?

While breast lifts are usually considered cosmetic procedures, insurance companies will sometimes deem them medically necessary and provide coverage. This is typically only the case if mastopexy is required when a particular amount of breast tissue is removed: breast reduction. More often, insurance companies do NOT cover this type of surgery.

How to Prove That a Breast Lift Is Medically Necessary?

If you believe that you may require breast lift surgery for medical reasons, an important first step is to consult with a board-certified plastic surgeon. They can perform an examination, review your health history, and help to determine whether a mastopexy is warranted to treat a health condition. The surgeon may order additional tests to fully evaluate the effects of your breast condition and write a letter of medical necessity explaining how a breast lift would be required to alleviate physical symptoms and improve functioning. This type of detailed documentation from an expert is the best way to demonstrate medical needs to an insurance company and get your breast lift surgery approved.
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Summary

Breast lifts can be considered a medical necessity to treat physical symptoms from conditions like severe sagging, asymmetry, complications from mastectomy, oversized breasts, deformities, or changes after major weight loss. If you think that you may qualify for insurance coverage, understanding these circumstances can help you get approval for mastopexy. Finding the right professional to evaluate your case and support your medical necessity claim is the first step toward your dream body. At Exert Clinic, our cosmetic surgeons will help you improve your shape and eliminate all bothersome symptoms.
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