Mastectomy Cost

Typical costs:

• For patients covered by health insurance, out-of-pocket costs for a mastectomy typically consist of doctor visit, lab and prescription drug copays as well as coinsurance of 10%-50% for the surgery. A mastectomy typically is covered by health insurance. However, some insurers have restrictions on mastectomy to prevent breast cancer. For example, Aetna^[1] considers prophylactic mastectomy medically necessary in patients with various risk factors, such as certain gene mutations.
• For patients not covered by health insurance, a mastectomy typically costs more than $15,000-$55,000 , not including breast reconstruction. For example, BlueCross BlueShield of Tennessee^[2] estimates a cost of more than $15,000 for a bilateral prophylactic mastectomy. Saint Elizabeth Regional Medical Center^[3] in Nebraska, charges about $14,000-$37,000 for a simple complete mastectomy. The hospital charges about $15,000-$32,000 for a modified radical mastectomy, which involves removal of breast tissue, nipple and some lymph nodes. Expect to pay about $37,000 for a radical mastectomy, which involves removal of breast tissue, nipple, underlying muscle and lymph nodes; costs can reach $50,000 or more if there are complications. Doctor fees and laboratory pathology costs can add up to $2,000 or more each to the total bill.

• A simple mastectomy^[4] might be recommended for a small tumor, and if the cancer has not spread to nearby lymph nodes. The patient is placed under general anesthesia, and the surgeon removes the entire breast, nipple and areola. A hospital stay of at least one night typically is required.
• A modified radical mastectomy^[5] typically is recommended when the cancer has spread to lymph nodes near the breast. The patient is placed under general anesthesia, and the surgeon removes the breast, nipple, areola and nearby lymph nodes. A hospital stay of at least one night typically is required.
• In a skin-sparing mastectomy^[6] , the surgeon removes the breast, nipple and areola, but leaves the skin in place. This typically is done when reconstruction is done immediately afterward, and both procedures can take up to six hours. If reconstruction is done, a hospital stay of five nights or longer might be required.
• The National Institutes of Health offers an overview^[7] of mastectomy.

• After a mastectomy, some patients will require radiation therapy^[8] , which can cost from less than $10,000-$50,000 or more, or chemotherapy, which can cost up to $30,000 or more, depending on the drug.
• Many patients choose to undergo breast reconstruction, which can be done at the same time as the mastectomy or months or even years later. This typically costs from $5,000-$15,000 or more per breast for implants or from $25,000-$50,000 or more per breast for "flap" techniques.
• Breast cancer patients will need regular follow-up doctor visits and screenings to check for recurrence. The American Society of Clinical Oncology offers guidelines for follow-up care that includes doctor visits every three to six months for the first three years, then less frequently, and a mammogram, which costs about $100, every six to 12 months.

• Many hospitals give discounts of up to 30% or more to uninsured/cash-paying patients. For example, Washington Hospital Healthcare System^[9] in California offers a 35% discount.
• Some state or regional programs offer free treatment. For example, the Commonwealth of Pennsylvania Breast and Cervical Cancer Prevention and Treatment Program offers free treatment^[10] to uninsured or underinsured women living in Pennsylvania who meet income guidelines. The United Breast Cancer Foundation offers grants^[11] to help pay for treatment for qualifying patients, typically those with income below two and a half times the federal poverty level.

• The Society of Surgical Oncology offers a surgical oncologist locator with the ability to search for a doctor who specializes in breast cancer surgery.
• The National Cancer Institute offers a guide^[12] to finding a doctor or cancer treatment facility.
• The National Institutes of Health offers a list of questions^[13] to ask about mastectomy and reconstruction.
• The National Cancer Institute has a fact sheet^[14] about preventive mastectomy for women who do not have breast cancer, but are at high risk.

1.  www.aetna.com/cpb/medical/data/200_299/0227.html
2.  www.bcbst.com/learn/treatment-options/prophylactic-mastectomy.shtm
3.  tp.chi.acelogicus.net/nese/Default.aspx
4.  www.mayoclinic.org/breast-cancer/simpletotalmastectomy.html
5.  www.mayoclinic.org/breast-cancer/radicalmastectomy.html
6.  www.mayoclinic.org/breast-cancer/skinsparingmastectomy.html
7.  www.nlm.nih.gov/medlineplus/ency/article/002919.htm
8.  www.rtanswers.org/treatmentinformation/cancertypes/breast/radiationaftermasectomy.aspx
9.  www.whhs.com/about/washington-hospital-discount-policy-for-uninsured/
10.  www.pabreastcancer.org/find-help/patient-resources/commonwealth-programs/
11.  www.ubcf.info/UBCF_Individual_Grant_Application_2009.pdf
12.  www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility
13.  www.nlm.nih.gov/medlineplus/ency/patientinstructions/000253.htm
14.  www.cancer.gov/cancertopics/factsheet/Therapy/preventive-mastectomy

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