Introduction
In New York City, the decision to remove silicone breast implants is a significant one for many women. Whether it's due to complications, personal preference, or other reasons, understanding the charging standards of hospitals for this procedure is crucial. This article will comprehensively explore the costs associated with silicone breast implant removal in NYC, including factors that influence pricing, average costs at different facilities, and insurance coverage aspects.
Factors Affecting the Cost of Silicone Breast Implant Removal
Type of Facility
The choice of facility where the implant removal surgery is performed plays a major role in determining the cost. There are two main types of facilities commonly used for this procedure: surgery centers and outpatient hospitals.
- Surgery Centers (Ambulatory Surgery Centers - ASCs): These are independent, licensed medical facilities. Procedures at ASCs are often less expensive. For example, the average cash price for breast implant removal care in New York at a surgery center is $3,412, according to Sidecar Health. They are governed by distinct regulatory requirements compared to hospitals. However, they typically offer fewer complimentary services and may not have the full - range of support services that a hospital provides.
- Outpatient Hospitals: These are outpatient departments or clinics that may be within or next to a hospital and are owned and run by the affiliated hospital. They can perform surgical treatments that do not require an overnight stay. The average cash price for breast implant removal at an outpatient hospital in New York is $6,165, almost twice as much as at a surgery center. But outpatient hospitals may offer more complimentary and support services for patients because they are connected to the hospital system.
Surgeon's Experience and Reputation
A highly experienced and well - known plastic surgeon may charge more for the procedure. Surgeons with a long track record of successful breast implant removal surgeries and positive patient reviews are likely to command a higher fee. Their expertise can be valuable in ensuring a safe and successful outcome, but it comes at a cost.
Complexity of the Procedure
The complexity of removing silicone breast implants can vary significantly from patient to patient. Some factors that contribute to complexity include:
- Implant Rupture or Leakage: If the silicone implant has ruptured or is leaking, the procedure becomes more complicated. The surgeon may need to remove not only the implant but also any leaked silicone gel and check the surrounding tissue for abnormalities. For example, at NYC Health + Hospitals - South Brooklyn Health / Ruth Bader Ginsburg Hospital and NYC Health + Hospitals - North Central Bronx, the removal of a ruptured breast implant has specific procedures associated with it, which may increase the cost.
- Scar Tissue: Over time, scar tissue can form around the breast implant. If the scar tissue is thick or adhered to the implant, it can be more difficult to remove. The surgeon may need to take extra care to remove the scar tissue without causing damage to the surrounding breast tissue, which can add to the time and complexity of the surgery.
Anesthesia and Medications
Anesthesia is required for breast implant removal surgery to ensure the patient's comfort. The type of anesthesia (local or general) and the duration of the procedure will affect the cost. Additionally, post - operative medications such as painkillers and antibiotics are also part of the overall cost. For instance, a common breast implant removal at both surgery centers and outpatient hospitals in New York includes the cost of hydrocodone - acetaminophen for pain management.
Additional Services
Some patients may require additional services such as a breast lift after implant removal, especially if the breasts are extremely saggy or the nipples droop extremely low. A breast lift surgery raises and reshapes the breast tissue, eliminates sagging skin, and relocates the nipples, giving the breasts a perkier look. This additional procedure will increase the overall cost.
Average Costs of Silicone Breast Implant Removal in New York City
Removal Only
According to Sidecar Health, the average cash prices for breast implant removal in New York are as follows:
| Facility Type | Average Cash Price |
|---|---|
| Surgery Center | $3,412 |
| Outpatient Hospital | $6,165 |
A breakdown of the components of the cost at a surgery center for a common breast implant removal includes:
| Category | Unit | Avg Cash Price |
|---|---|---|
| General Surgeon Visit Provider Fee (First time visit, Standard) | 1 | $144 |
| Provider Fee to Remove Breast Implant Material (Standard) | 1 | $953 |
| Surgery Center Fee to Remove Breast Implant Material (Standard) | 1 | $1,613 |
| Prescriptions (Hydrocodone - acetaminophen, Standard) | 30 | $18 |
| Anesthesiologist Fee to be "Put Under" for Procedure (Level 2, Standard) | 1 | $155 |
| Anesthesiologist Time to be "Put Under" for Procedure (Per minute, Standard) | 229 | $528 |
| Total Average Cash Price | - | $3,411.51 |
At an outpatient hospital, the breakdown is as follows:
| Category | Unit | Avg Cash Price |
|---|---|---|
| General Surgeon Visit Provider Fee (First time visit, Standard) | 1 | $144 |
| Provider Fee to Remove Breast Implant Material (Standard) | 1 | $953 |
| Outpatient Hospital Fee to Remove Breast Implant Material (Level 1, Standard) | 1 | $4,367 |
| Prescriptions (Hydrocodone - acetaminophen, Standard) | 30 | $18 |
| Anesthesiologist Fee to be "Put Under" for Procedure (Level 2, Standard) | 1 | $155 |
| Anesthesiologist Time to be "Put Under" for Procedure (Per minute, Standard) | 229 | $528 |
| Total Average Cash Price | - | $6,165.35 |
Removal and Replacement
If a patient decides to have the breast implants removed and replaced at the same time, the costs are higher. Sidecar Health reports the following average cash prices in New York:
| Facility Type | Average Cash Price |
|---|---|
| Surgery Center | $9,455 |
| Outpatient Hospital | $16,596 |
Insurance Coverage for Silicone Breast Implant Removal
Medically Necessary Situations
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) states that if the implants were put in after a mastectomy and the doctor believes that removing the implants is “medically necessary,” then health insurance is legally obligated to cover the breast implant removal. Additionally, many insurance companies consider removal of breast implants medically necessary for patients with certain conditions:
- Ruptured silicone gel breast implants
- Severe capsular contracture
- Infections that don’t go away
- Chronic breast pain
- Breast implant - associated anaplastic large cell lymphoma (BIA - ALCL), a cancer of the immune system
Medicare usually covers breast implant (saline or silicone) removal for conditions such as painful capsular contracture with disfigurement, implant rupture, infection, implant extrusion, interference with the diagnosis of breast cancer, and siliconoma or granuloma. However, Medicare coverage can differ depending on the state where you live.
Cosmetic Reasons
If the original reason for getting breast implants was for augmentation of healthy breasts and the removal is for cosmetic reasons, most insurance companies will not cover the cost. Some may not even cover complications from previous cosmetic procedures. However, it's still important to check your specific insurance policy.
Checking Insurance Coverage
To find out if your insurance company is likely to cover the removal, you need to look at your specific policy language. This can usually be found in a document called “Evidence of Coverage” (EOC), also known as a “Benefits booklet.” You can access an electronic copy through your online account on your insurance company’s website or call the member services number on the back of your insurance card to request a copy.
When reviewing the policy, look for language about breast implant removal. If not found, search for language on complications from cosmetic surgery or the definition of “medically necessary.” Also, check if your insurance plan requires pre - authorization for any surgeries.
Pre - authorization and Reimbursement
Most insurance companies require pre - authorization before the surgery. This involves having your plastic surgeon sign and submit a letter that lists your symptoms and explains why removal is medically necessary based on your insurance policy language, along with any medical documentation that provides proof of your symptoms. If your surgeon is in your insurance company network, he/she should file a claim on your behalf. If not, you will have to pay upfront for the surgery and file a reimbursement claim with your insurance company.
What to Expect During and After Silicone Breast Implant Removal
During the Procedure
Before the surgery, the patient is given anesthesia. The surgeon makes an incision, usually along the lower fold of the breast or around the areola, often using the same incision site as the original breast augmentation surgery. The implant is then removed, and any excess scar tissue may also be taken out. Cells from the surrounding tissue may be examined by a pathologist to check for abnormalities, especially in cases of ruptured implants. The incisions are then closed with sutures, tape, or other skin adhesives, and gauze and a surgical garment are placed over the chest to minimize swelling.
After the Procedure
Recovery from breast implant removal surgery takes several weeks. Immediately after surgery, the patient will experience some swelling and pain in the chest area and may feel more discomfort in the arms or upper body for several weeks. The doctor will prescribe pain medication and instruct the patient on how to care for the incision sites to prevent infection and promote faster healing. A compression garment may need to be worn for a few weeks to facilitate healing. Some patients may need small drain tubes under the skin to drain blood and other fluid, which will be removed a few days after the surgery.
Conclusion
In New York City, the charging standards for silicone breast implant removal vary based on multiple factors such as the type of facility, surgeon's experience, complexity of the procedure, anesthesia and medications, and additional services. The average cash prices at surgery centers are generally lower than at outpatient hospitals, but the latter may offer more support services. Insurance coverage also plays a significant role, with coverage depending on whether the removal is considered medically necessary or for cosmetic reasons.
If you are considering silicone breast implant removal in New York City, it's essential to consult with a qualified plastic surgeon to understand the specific costs associated with your case. Also, thoroughly review your insurance policy to determine if and how much of the cost will be covered. Don't hesitate to ask questions and explore your options to make an informed decision about your health and well - being. Share this article with others who may be interested in learning about breast implant removal costs in NYC and encourage them to seek professional advice for their specific situations.
