When does health insurance pay for breast surgery?

This question is asked by many women who wish to have an operation because their breasts are too small or too large or because they have bulging breasts. In which cases the health insurance company will cover part of the costs can be answered here based on our experience.

Costs for breast augmentation or breast lift

A breast augmentation or a breast lift for purely cosmetic reasons is not covered by basic insurance and is not a mandatory benefit. In the following cases, an application can be made for the costs to be covered:

• Correction due to an illness, e.g. an amputation as a result of cancer
• Developmental disorder, such as Poland syndrome

Unfortunately, we have found that the costs are almost never covered for clear asymmetries and very small breasts. Even cavity corrections are not covered by health insurance companies. In all these cases, the focus is on aesthetics and not health, the insurers argue.

In Switzerland, some health insurance companies offer supplementary insurance for cosmetic surgery. However, even then the costs are only covered under certain conditions.

Costs covered for breast reduction

Breast reduction is also not a compulsory service that is covered by basic insurance. However, the costs will be covered by health insurance on application, provided that certain conditions are met:

• Fundamentally, documented complaints and non-aesthetic problems must be the reason for the application for coverage
• The problem must have a demonstrable disease value. The health insurance company does not assess the visible size of the breast, but whether the overly large breast causes health problems such as back or neck pain. This means that conservative treatment of the complaints has already been carried out for a long time without success. This proof must be provided by means of treatment records from the treating physiotherapists and doctors.
• It is also required that the patient is of normal weight (BMI > 25). Therefore, the application must also include information on body size, current body weight and bra size
• Based on photo documentation, the attending physician must show that the estimated surgically removed breast tissue is at least 500 g per side. 500 g per side and that the breast size is proportionate.

If all these criteria are met, an application for reimbursement can be submitted with a prospect of success. The decision lies with the medical examiner of the respective health insurance company and is therefore a discretionary decision that can still be contested in the event of an obviously poorly justified rejection.

A breast surgery at Breast Atelier: Quality surgery at a transparent fixed price

The Breast Atelier's team of doctors consists of specialists with several years of professional experience who work under the medical supervision of Dr. med. Cédric A. George, the founder of the Pyramid Clinic (today Plastic Surgery Pyramid), which is renowned far beyond the country's borders. His Center for Plastic Surgery, which is now one of the market leaders in Switzerland, has set the standards in terms of quality and reliability in plastic reconstructive and aesthetic surgery.

Under the patronage of the Plastic Surgery Pyramid, these standards are also accessible to a wider audience in the Breast Atelier. Our specialists in plastic surgery are the guarantors of quality surgery.

Book your free consultation appointment

Arrange your free consultation appointment directly online to get all your questions answered and see the Breast Atelier for yourself. Our specialist doctors are at your disposal.