Symmetrical Appearance
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Privacy, Policy & Legal Issues > Laws & Protections > Women's Health & Cancer Rights Act

Achieving balanced breasts through reconstruction

The Women’s Health and Cancer Rights Act (WHRCA) requires that most group health plans cover all stages of reconstruction of the breast(s) on which a mastectomy was performed. It also stipulates coverage of surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance. 

Surgery on a breast without cancer to establish symmetry with the opposite breast is considered medically necessary when it is related to breast reconstruction following a mastectomy. Methods to create breasts of similar size and shape may include:

  • Breast reduction (reduction mammoplasty) 
  • Breast lift (mastopexy)
  • Enhancement with a breast implant
  • Autologous tissue reconstruction (e.g. DIEP, TRAM, SIEA, or Latissimus dorsi flap)
  • Fat grafting

Some health insurers consider fat transfer or grafting experimental and refuse coverage of this technique. However, the American Society of Plastic Surgeons states, “Autologous fat grafting should [not] be considered experimental but should be regarded as part of reconstructive surgery when it is performed to approximate a normal appearance of the breasts following mastectomy or lumpectomy.”

Medicare & Medicaid

Medicare and Medicaid are public programs that are not bound by the WHRCA. They have their own rules. Medicare covers breast reconstruction after a "medically necessary" mastectomy typically associated with a cancer diagnosis, while Medicaid coverage varies by state.

See the Insurance & Paying for Care section of our website for more information.

Paying For Care
Paying For Care

  • Alliance in Reconstructive Surgery (AiRS) Foundation provides grants to offset the costs of breast reconstructive surgery for women in need.
  • If your insurance company denies coverage of care related to your breast reconstruction following mastectomy, visit the Health Insurance Appeals section of our website for guidance and resources.
  • Medicare Rights Center is a national nonprofit organization that works to ensure access to affordable health care for older adults and people with disabilities under the Medicare program.
  • Patient Advocate Foundation provides case managers who help identify financial assistance programs and resources for those facing challenges.