Breast Implant Removal (CPB 0142, reviewed 2026-03-19)
Summary
Aetna considers breast implant removal medically necessary for members who had cosmetic augmentation or breast reconstruction after a medically necessary mastectomy and who meet at least one listed criterion. The criteria include breast cancer in the implanted or contralateral breast where implant removal is necessary to excise the cancer, breast implant-associated anaplastic large cell lymphoma, implant extrusion through the skin, recurrent infections, Baker Class IV contracture associated with severe pain, severe contracture that interferes with mammography, intra- or extra-capsular rupture of silicone gel-filled implants, cutaneous hypersensitivity-like reactions that failed conventional treatments, and persistent pain, lumps, swelling or asymmetry in textured implants after the surgical incision has fully healed. Requests for removal for Baker Class III contracture that does not follow a medically necessary mastectomy, for a biopsy of a breast mass not proven to be cancerous, or for a mastectomy or lumpectomy that can be performed with the implant in place are subject to medical review. Aetna does not consider IgG testing in connection with silicone implants medically necessary, and it does not consider removal of silicone implants for autoimmune disease medically necessary unless a selection criterion is met.
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