3.0 POLICY
3.1 Removal
of silicone or saline breast implants is covered if the initial
silicone or saline breast implantation was, or
would have been, a covered benefit.
3.2 Signs or symptoms of complications
must be present and documented. Current medical literature supports
removal of silicone or saline breast implants for the following
indications:
• Signs and symptoms that may
signal implant rupture; and
• Capsular contracture.
3.3 If the initial silicone or
saline breast implant surgery was for an indication not covered
or coverable by TRICARE, implant removal may be covered only if
it is necessary treatment of a complication which represents a separate
medical condition. See
Section 1.1.
3.4 Breast Magnetic Resonance Imaging
(MRI) to detect implant rupture is covered. The implantation
of the breast implants must have been covered by TRICARE if
the initial silicone or saline breast implantation was, or would
have been, a covered benefit.
4.0 EXCLUSIONS4.1 Removal of silicone
or saline breast implants for the presence of autoimmune or connective tissue
disorders.
4.2 In
the case of implants not originally covered or coverable, implant
damage, hardening, leakage, and autoimmune disorder do not qualify
as separate medical conditions. They are considered unfortunate
sequelae resulting from the initial non-covered surgery, and, therefore,
are excluded.