Introduction: You Have Options—And Coverage
Whether you’re preparing for mastectomy, living with uncomfortable implants, or considering a more natural, permanent reconstruction, insurance should not be the barrier. Under federal law, most plans that cover mastectomy must also cover breast reconstruction, including DIEP flap surgery. At Portsmouth Regional Hospital, The DIEP Group helps patients throughout New Hampshire and Southern Maine navigate benefits, preauthorization, and (when needed) appeals—so you can focus on healing, not paperwork.
Good to know: DIEP flap is typically covered at the time of mastectomy or years later as a delayed procedure. You do not need to have implant problems to switch from implants to DIEP—many patients choose DIEP proactively to avoid future exchanges or silicone leaks.
Service area: Portsmouth, Manchester, Concord, Nashua, Dover, Rochester, Keene, Derry, Salem, Hampton, Exeter — plus Southern Maine including Portland, York, Kennebunk, Biddeford, Kittery, Saco, Scarborough.
Visit our Before and After DIEP Flap Gallery
The Law That Protects You (WHCRA)
The Women’s Health and Cancer Rights Act (WHCRA) requires most group health plans and insurers that cover mastectomy to also cover:
- Breast reconstruction on the affected breast (including DIEP flap)
- Surgery on the opposite breast for symmetry
- Prostheses, if needed
- Treatment of complications, including issues from prior reconstruction (e.g., capsular contracture) and lymphedema
This applies to immediate (same operation as mastectomy) and delayed (months or years later) reconstruction.
When Insurance Typically Approves DIEP Flap
- Immediate DIEP at mastectomy (unilateral or bilateral)
- Delayed DIEP after previous lumpectomy/mastectomy
- Failed implant reconstruction or poor cosmetic/functional results
- Radiation-related implant problems (tightness, pain, deformity)
- Hard implants with capsular contracture
- Rupture/suspected leakage or anxiety about monitoring
- Recalled textured silicone implants seeking device removal
- Elective implant-to-DIEP conversion to avoid future exchanges and leaks (coverage commonly applies even without active implant problems)
Implants vs. DIEP Flap: The Coverage Reality Patients Ask About
| Consideration | Implants | DIEP Flap (Autologous) |
| Coverage after mastectomy | Typically covered | Covered (immediate & delayed) |
| Lifespan | Often replaced ~10–15 years | Permanent (no device to replace) |
| Radiation tolerance | Higher risk of problems | Often preferred post-radiation |
| Feel/temperature | May feel firm/cool | Soft, warm, natural |
| Leak/rupture risk | Yes | No (your own tissue) |
| Body changes | Does not adapt | Changes with you (weight gain/loss) |
| Abdominal benefit | None | Tummy-tuck–like contouring |
Key takeaway: Many patients shift to DIEP to stop the cycle of implant exchanges and monitoring and to gain a natural, permanent result—with insurance coverage.
How We Handle Insurance—Step by Step
1) Pre-verification of benefits
We confirm your plan covers post-mastectomy reconstruction, review any requirements (e.g., referral, imaging), and check facility/hospital network status.
2) Documentation & medical necessity packet
- Oncologic/mastectomy notes or prior reconstruction records
- Details of implant complications (if applicable): capsular contracture, rupture, radiation changes, recalled devices
- Photos (when requested by the insurer)
- Proposed operative plan and CPT/diagnosis codes
3) Preauthorization submission
Our team coordinates with your insurer to secure written approval before surgery.
4) If denied: targeted appeal
We address the denial reason point-by-point, provide surgeon letters and literature, and request a peer-to-peer review if helpful.
5) Cost transparency
We explain any potential out-of-pocket responsibilities (deductibles, co-insurance, copays) upfront so there are no surprises.
Common New Hampshire & Southern Maine Insurers We Work With
We routinely coordinate with major regional plans, including many PPO/HMO options. Even if your plan is less common or self-funded, we’ll verify benefits and pursue authorization. (Plan names and networks vary—we’ll confirm specifics for your policy.)
Out-of-Pocket Costs: What Patients Usually Ask
- Deductible & co-insurance: Based on your plan.
- Copays: For hospital and specialist visits.
- Out-of-network considerations: When possible, we help arrange in-network care or single-case agreements.
- Additional procedures: Symmetry, revisions, nipple reconstruction, and tattooing are often covered when related to mastectomy reconstruction.
The “Tummy Tuck” Question (and Coverage)
Patients search for: “Is DIEP flap like a tummy tuck?”
DIEP uses lower-abdominal tissue, so many patients enjoy a flatter, smoother belly and improved waist contour—a tummy-tuck–like benefit. Because this contouring occurs as part of breast reconstruction, it’s typically covered under reconstruction benefits (it’s not billed as a cosmetic abdominoplasty).
Immediate vs. Delayed DIEP: Which Is Better for Coverage?
Both are usually covered. The choice depends on cancer treatment timing, need for radiation, and your personal goals. Many patients opt for delayed DIEP after radiation to allow the breast skin and chest wall to settle; others choose immediate DIEP to wake up with a breast mound and avoid a separate operation later. Either path is insurable—we’ll plan the best route for you with your oncology team.
Switching from Implants to DIEP: Covered Scenarios
- Capsular contracture (painful/hard)
- Radiation-damaged implants (tightness, asymmetry)
- Recalled textured implants (desire for removal)
- Rupture/suspected leak
- Elective switch to a permanent, natural option—covered even without current implant problems in most plans
Recovery & What Insurance Typically Includes
- Hospital stay (usually 2 days) at Portsmouth Regional Hospital
- ERAS pain control and microsurgical monitoring
- Follow-up visits and routine postoperative care
- Revisions and symmetry procedures when needed
- Nipple reconstruction and 3D areola tattooing related to mastectomy reconstruction
Patient Testimonial — Concord, NH
“I was worried my plan wouldn’t cover DIEP because I already had implants. The DIEP Group took care of the authorization and the appeal. I had my surgery at Portsmouth Regional Hospital, and now everything feels soft and natural. I’m relieved I won’t need implant exchanges anymore—and yes, my stomach is flatter.”
— T.M., Concord, NH
FAQs — Insurance & DIEP Flap for NH & Southern Maine
Is DIEP flap covered if I had my mastectomy years ago?
Yes—delayed DIEP is typically covered, even many years later.
Can I switch from implants to DIEP if my implants are “fine”?
Yes. Elective implant-to-DIEP conversion is commonly covered to provide permanent, device-free reconstruction.
Does insurance cover the removal of recalled textured implants and DIEP in the same setting?
Often yes. We handle documentation and preauthorization for device removal and DIEP reconstruction.
What about DIEP after radiation?
Autologous tissue is often favored after radiation, and coverage applies.
Are revisions and symmetry covered?
In most cases yes, when related to mastectomy reconstruction.
Will insurance cover nipple reconstruction and tattooing?
Usually yes as part of post-mastectomy reconstruction benefits.
Do I need to go to Boston for coverage or expertise?
No. Portsmouth Regional Hospital offers advanced DIEP reconstruction close to home for NH and Southern Maine patients—with coverage.
Service Areas
New Hampshire: Portsmouth, Manchester, Concord, Nashua, Dover, Rochester, Keene, Derry, Salem, Hampton, Exeter
Southern Maine: Portland, York, Kennebunk, Biddeford, Kittery, Saco, Scarborough
Internal Links
- DIEP Flap Breast Reconstruction in Portsmouth, NH — Complete Guide
- DIEP Flap Recovery in Portsmouth, NH — What to Expect
- Insurance Coverage for DIEP Flap in NH & Southern Maine
Take the Next Step
If you’re planning mastectomy, living with uncomfortable implants, or ready to switch to a natural, permanent reconstruction, we’ll help you secure coverage and plan your surgery at Portsmouth Regional Hospital.
The DIEP Group
203-200-0828
thediepgroup.com
Portsmouth Regional Hospital, Portsmouth, NH
