Does Medicare cover breast implant removal?

Medicare contractors in many regions use the same list. They cover taking out an implant for any one of these reasons:

• The implant is broken or has failed, such as a rupture or leak.
• There is an infection or a strong reaction to the implant, or your body is rejecting it.
• The implant is pushing out through the skin.
• Silicone has caused lumps in the tissue (called a siliconoma or granuloma).
• The implant gets in the way of finding breast cancer.
• Scar tissue around the implant has hardened and is painful and has changed the shape of the breast (called capsular contracture).

These rules apply whether your implants were put in after cancer or only for looks.

In short: if the implant is causing a medical problem on this list, Medicare covers removing it, even if the first surgery was cosmetic.

• Removal for cosmetic reasons. If you want the implants out only because you do not like how they look or feel, and there is no medical problem on the list, Medicare treats it as cosmetic.
• New cosmetic implants. If your first implants were only for looks, Medicare does not pay to put new ones in after removal.
• Reshaping the breasts to improve how they look, such as a lift that is not part of reconstruction.

For cosmetic surgery Medicare does not cover, you pay the full cost.

The rules are broader after a mastectomy. Medicare covers breast reconstruction after a medically necessary mastectomy, for the breast that was removed and for the other breast so they match. This includes surgically placed implants.

• Part A covers implants placed during an inpatient hospital stay.
• Part B covers the surgery if it is outpatient.
• Part B also covers some external breast forms and a post-surgery bra.

So if you had implants after breast cancer and need them replaced, new implants can be covered too.

If the removal is outpatient surgery: after the $283 Part B deductible for 2026, you pay 20% of the Medicare-approved amount for the surgeon. In a surgery center, you also pay 20% of the center's approved amount. In a hospital outpatient department, you pay a copayment to the hospital. In most cases, that copayment cannot be more than the Part A deductible for each service.

If you are admitted to the hospital, Part A covers the stay after the $1,736 Part A deductible for each benefit period in 2026.

• If you have a Medigap plan: it can help pay your share of Part A and Part B costs.
• If you have Medicare Advantage: your plan sets its own copays. Check your plan's Evidence of Coverage.
• If you have Medicaid too: Medicaid may pay your share. Ask your state Medicaid office.

1. See your doctor about the symptoms. Pain, a change in shape, swelling, or signs of infection should all go in your record.
2. Get any tests your doctor orders. The results belong in your record.
3. Make sure your record names the reason. The surgeon's notes should match one of the reasons on Medicare's list.
4. Choose a surgeon who takes Medicare. Ask whether the surgery will be in a surgery center or a hospital, and what you will owe.
5. Read any form before you sign it. If the surgeon thinks Medicare may not pay, they may ask you to sign an Advance Beneficiary Notice. Signing it means you agree to pay if Medicare says no.
6. If Medicare says no, appeal. Your Medicare Summary Notice explains how.