Breast augmentation can transform a woman's life, whether to restore a harmonious figure after a pathology or to correct a malformation. But the cost of such surgery is considerable, and reimbursement by the Assurance Maladie is only possible in certain very specific situations. How do you know if the operation is covered? What steps need to be taken, and what costs are involved? Here's everything you need to know.
Prise en charge d’une Augmentation mammaire : dans quels cas un remboursement est-il possible ?
Reimbursement of breast augmentation by the French Assurance Maladie is only possible if the operation is based on a proven medical necessity.
Severe breast hypoplasia, characterized by an extremely small breast volume (cup size less than A), may warrant treatment. The same applies to cases of bilateral breast agenesis, where the breasts have not developed at all.
Some congenital malformations, such as Poland syndrome or tuberous breasts, cause significant asymmetries that can also be recognized.
After a mastectomy for breast cancer, breast reconstruction is covered by the French Assurance Maladie. In each of these situations, a plastic surgeon must certify that the operation is medically necessary, and submit a file accordingly.
Conditions for reimbursement of breast augmentation by social security
The agreement of the Assurance Maladie is based on several precise criteria. The procedure must be carried out in an approved establishment, and be the subject of a request for prior agreement, drawn up by a plastic surgeon. This document details the pathology and medical reasons justifying the surgery.
The Assurance Maladie then examines the file and may summon the patient for an assessment by a medical officer. If the breast augmentation is purely cosmetic, the application will be systematically rejected. So it's important to be well informed before taking any steps.
How can I obtain reimbursement for breast augmentation?
The process begins with a consultation with a plastic surgeon, who assesses the medical situation and determines whether the procedure is eligible for reimbursement. If the criteria are met, a request for prior agreement is drawn up and sent to the CPAM.
The Assurance Maladie then has 15 days to respond. If no reply is received within this period, approval is deemed to have been given. However, the patient may be called in by a medical officer to confirm the need for the operation. To optimize the chances of acceptance, it is advisable to support the request with concrete evidence: medical photographs, detailed surgeon's report and proof of the physical or psychological impact of the injury.
Discover our article on the cost of breast prosthesis replacement.
Is a reimbursed breast augmentation completely free?
Even when reimbursement is granted by the Assurance Maladie, certain costs remain payable by the patient. Surgeons' and anesthetists' fees are frequently exceeded, particularly in sector 2. Depending on the practitioner, pre-operative consultations may not be fully reimbursed.
Post-operative care, such as dressings, medication or follow-up consultations, represents an additional cost. What's more, the post-operative medical bra, essential for a good recovery, is not covered.
A complementary health insurance plan can sometimes cover part of these costs. It is therefore advisable to check your coverage before the operation to avoid any unpleasant surprises.
Quel est le prix d’une augmentation mammaire hors prise en charge ?
When the procedure is performed without reimbursement, the price of breast augmentation by prosthesis varies according to the type of implant and the technique used. Motiva round implants cost between €5,900 and €7,500, while Mentor saline implants cost between €5,500 and €6,500.
Breast augmentation by lipofilling, which uses the patient's own fat, is a little more expensive, costing between 6,500 and 7,500 euros. A correction of breast ptosis is estimated at between 6,500 and 8,000 euros.
For a plastic prosthesis, which combines implants and ptosis correction, you need to budget between 7,500 and 9,000 euros.
Added to this are pre-operative consultations, billed at between 80 and 100 euros, and any additional costs, such as compression garments or follow-up care.
A detailed estimate is always drawn up by the surgeon so that the patient can anticipate all expenses. Some clinics also offer payment facilities to make the operation more affordable.
Découvrez notre article sur le sujet du remboursement d’un lipofilling mammaire.
What you need to know about coverage and reimbursement for breast augmentation
- Breast augmentation can only be reimbursed by the French Assurance Maladie if it is justified by a pathology or malformation as part of reconstructive or reparative surgery. Severe hypoplasia, congenital malformations and post-mastectomy reconstruction are the main recognized medical indications.
- A request for prior agreement is essential to obtain approval.
- However, even when reimbursed by the Assurance Maladie, there are still additional costs, such as extra fees and post-operative care.
- For purely aesthetic breast augmentation, prices vary according to the technique and the facility chosen.
- Before taking the plunge, it's important to anticipate these financial aspects and compare the options offered by surgeons and care facilities, so as to choose the solution best suited to your expectations and budget.
