Breast Reconstruction Surgery: FSA Eligibility

Breast reconstruction surgery reimbursement is eligible following a mastectomy for the treatment of cancer with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Breast reconstruction surgery is not eligible for reimbursement with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

What is breast reconstruction surgery?

Women who are diagnosed with breast cancer at an early stage have a wealth of treatment options available to them, but two of the most common options to quickly eliminate a massive amount of risk of the cancer spreading are a mastectomy and lumpectomy. A mastectomy surgery removes all breast tissue from a breast, while lumpectomy aims to conserve the breast tissue by only removing the tumor that may be present. In both of these cases, women may opt for breast reconstruction surgery performed by a plastic surgeon to recreate the look of healthy breast tissue after this tissue is altered or removed completely. Because this surgery is part of the treatment of a disease, the law says that insurance providers must provide coverage.

How is breast reconstruction surgery performed?

The decision to have breast reconstruction surgery is not to be taken lightly, as this is a major invasive surgery that can vary based on what technique is used, as well as a significant recovery period after the procedure is completed. There are two primary forms of breast reconstruction surgery, including:

  • Breast Implants: If women so choose, direct-to-implant reconstruction surgery is an option where implants are put in at the same time the mastectomy is performed. After the breast tissue is removed, a plastic surgeon will place a breast implant beneath the muscle of the chest, and a special type of graft or absorbable mesh is used to hold the implant in place. Otherwise, women can pursue two-stage reconstruction surgery which involves a short-term tissue expander that is placed after the mastectomy surgery. The patient then receives a series of injections of saline until the desired breast size is achieved. The expander is removed, a permanent implant is placed and nipple/areolar construction completes the process.
  • Tissue Flap Procedures: The other option for women post-mastectomy is the tissue flap procedure, in which breast tissue is reconstructed by repurposing tissue from a different part of the body. Tissue from the back, buttocks, thighs or stomach can be used for the surgery, but the two most common are from the lower abdomen and back: TRAM - transverse rectus abdomen muscle flap and the latissimus dorsi flap. These procedures typically have longer recovery times than implant procedures, but offer the benefit of looking more natural and require far less maintenance in the future.

Eligibility Table

Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)

Eligible

Eligible with Rx

Eligible with LMN

Not Eligible

Specifically Not Covered

Breast reconstruction surgery for cosmetic purpose only is not eligible.

Legal Information / Regulations

Revenue Ruling 2003-57

 


AZ-PROD-WEB02 11/20/2017 5:08:03 PM