
Social security coverage cases are quite rare and can be illustrated corresponding to cases of breast augmentation, breast ptosis or breast reduction.
Breast augmentation and social security
Boob job or Breast augmentation is cosmetic surgery that involves increasing the volume of the breast. In principle, this is pure cosmetic surgery and there is then no coverage by social security. This means that all costs related to the intervention are your responsibility.
The mutual fund cannot cover anything insofar as it can only intervene in the case of surgery with social security coverage. In very rare cases, support is possible and subject to prior agreement with social security.
What are the conditions for coverage by social security
The cases of management are the total absence of mammary gland (a thorax like that of a man for example), significant breast asymmetries (at least two cup sizes apart) or certain rare cases of breast malformation such as tuberous breasts for example. Either by detailing a little more these different cases, we therefore have:
- Bilateral mammary agenesis: It is the total absence of breast. Consider a thorax with an areola and an isolated nipple without a breast at all.
- Severe bilateral breast hypoplasia with a cup size smaller than A: This does not mean that when her bra size is smaller than A, the treatment is effective. This means that the breast must be really underdeveloped although it exists with a size that does not fill the A cup. It is your surgeon who will judge during the consultation if you can be eligible for treatment.
- Finally, breast malformations of the tuberous breast type. Tuberous breasts are a very special entity, not just sagging breasts with large areolas. These are small breasts that look like small tubes with a bulging, enlarged areola.
In all cases, the assumption of responsibility requires a prior agreement request. This is an administrative document completed and issued by your surgeon during the first consultation. This document is nominative for the surgeon. This means that the agreement, if given, will only concern this surgeon. Basically, if you don’t expect to be operated on by the surgeon who completed the agreement, you don’t need to send it to your caisse.
This document must then be sent to your primary health insurance fund. You will be systematically summoned within 15 days to a medical consultant who will rule on your case and his response will be sent undercover to the surgeon concerned. It is therefore up to him to warn you of the acceptance or the refusal.
In practice, patients are often informed directly by the medical adviser, especially in the event of an agreement, so that they can begin to organize themselves.
Breast ptosis and social security
Breast ptosis is an intervention which consists in raising a breast is an intervention of cosmetic surgery for which no support is possible by social security. This breast intervention can be combined with breast augmentation or breast reduction. If breast reduction is considered, treatment is possible under the conditions below.
Breast reduction and social security
A case of support has been provided for by social security. This is a breast reduction greater than 300 grams per breast. This corresponds to a size reduction of at least two cups. For example, a woman who has a D cup will have to accept a switch to a minimum B cup. In this case, the coverage is done automatically without requesting coverage from social security.
We therefore see that the cases of coverage by social security are limited and are linked either to a total absence of mammary gland, to tuberous breasts or to patients who can justify a reduction of 300 grams per breast.