Insurance Coverage

The Women’s Health and Cancer Rights Act (WHCRA) of 1998 provides 3 options for those interested in breast reconstruction.  Which includes external prosthesis, implant-based reconstruction, or autologous reconstruction via transfer of tissue from another area of their body.

Each option selected is based on individual needs.  Including extent of disease, available tissue quality, and a patient’s reconstructive goals.  Which may include required resection of the nipple-areola complex.

Wording of the WHCRA suggests that a patient’s breast(s) be restored to a natural symmetric appearance.  Unfortunately, the wording is vague, left for interpretation, and does not include 3D areola tattoo.  Nor does it dictate what is to be considered “medically necessary.”

As we know, tattoo may be the only option for those with radiation-associated tissue damage.  As well as for those who do not wish to undergo additional surgery.

Although WHCRA was intended to increase accessibility of breast reconstruction services, it only applies to private insurance companies.  Churches, state and federal programs, such as Medicare or Medicaid, are exempt from WHCRA.  Many private insurance companies will cover nipple-areola complex tattooing, but only based upon their individual interpretation of WHCRA, as well as preference (or requirement) that the procedure be performed by a plastic or reconstructive surgeon only and within a medical office or facility.  This poses many challenges, making it difficult to receive insurance coverage.

REFERENCES

Butler, P. D., Plana, N. M., & Hastings, A. L. (2019). Finishing touches. Plastic and Reconstructive Surgery - Global Open, 7(11). https://doi.org/10.1097/gox.0000000000002558