Most women who suffer from breast enlargement are unaware that their breast reduction in Paris can be almost entirely covered by the Social security firstly, by their mutual then. Not because the information doesn't exist, but because no one has given it to them clearly. If your chest is causing you back pain, and neck pain or skin irritations Here's how double reimbursement really works, what's left to pay under your contract, and how Dr. Djian can help, plastic and aesthetic surgeon in Paris, can help you get started.
Breast hypertrophyor macromastia, refers to an excessive development of breast volume, generally of congenital or hormonal. It is medically defined by a breast volume equal to or greater than 300 cm³ per breast, i.e. approximately an E or F cup. Beyond the aesthetic discomfort, this condition has physical and psychological repercussions that may justify surgical treatment.
A breast reduction, also known as a bilateral reduction mastoplasty, is medically indicated for :
Intervention can be envisaged from age 16 when hypertrophy causes disabling pain. Generally speaking, a patient who has undergone from an E or F cup to a C or D cup.
For a breast reduction to be reimbursed by the Assurance Maladie, the surgeon must remove at least 300 grams of mammary gland per breast. This threshold corresponds to a reduction of around two cup sizes. When this volume is reached, the procedure is coded QEMA013. in the Common Classification of Medical Acts (CCAM) and does not require no prior agreement required with the CPAM medical officer. This surgery entitles you to compensated work stoppage, lasting 2 to 3 weeks depending on your professional activity.
If the volume removed is less than 300 g per breast, the procedure is reclassified as cosmetic surgery, and no reimbursement or sick leave is possible.
A legal cooling-off period of at least 15 days before any operation must be respected between the signature of the estimate and the date of surgery. This period is systematically respected as part of the usual pre-operative course.
In case of’significant breast asymmetry, a partial coverage may be considered. The gap between the two breasts is assessed on a case-by-case basis by the Assurance Maladie medical department, but corresponds to usually at least two cup sizes. The Assurance Maladie medical department then evaluates the‘he functional and psychological impact of this asymmetry when deciding on reimbursement.
Most mutual insurance companies also cover a unilateral breast reduction in this context, whether it's a natural asymmetry or following a cancer treatment.
When a breast reduction is carried out as part of a oncology care, to rebalance the breasts after conservative surgery or a reconstruction, The cost of this treatment is reimbursed at 100 % of the conventional Social Security rate, as part of the ALD (Affection de longue durée). Any excess fees in the private sector are the responsibility of the patient or her mutual insurance company.
Several situations can lead to a refusal to take charge:
In all cases, a consultation with Dr. Djian will enable us to assess your situation accurately and put together a complete medical file to maximize your chances of treatment.
When the criteria are met, the CPAM covers 100 % of the agreed basic rate. This rate covers the basis of reimbursement for surgery and hospitalization in an approved establishment.
The daily hospital charge The remainder is paid by the patient or her mutual insurance company.
Social security coverage does not mean that the operation is free, particularly in private clinics. From excess fees apply to surgeon's fees and the anaesthetist. Your mutual insurance company will cover all or part of these costs.
Here is a fictitious simulation to better understand the reimbursement breakdown between social security and your mutuelle :
| SS base (CPAM) |
Mutual insurance | Reste à charge | |
|---|---|---|---|
| Cost of operation | - | - | 4 500 € |
| CPAM reimbursement | 400 € | - | - |
| Excess fees | - | - | 4 100 € |
| Mutuelle basique - 100 % base SS | 400 € | 0 € | 4 100 € |
| Mutuelle standard - 200 % base SS | 400 € | 400 € | 3 700 € |
| Mutuelle confort - 300 % base SS | 400 € | 800 € | 3 300 € |
| Mutuelle frais réels | 400 € | 4 100 € | 0 € |
Indicative simulation based on a total cost of €4,500 and a basic CPAM tariff of around €400. The exact amounts vary according to the practitioner's sector and your contract cover. Send Dr. Djian's estimate to your mutual insurance company for a personalized simulation. Some contracts require a prior payment sent before the date of surgery.
At the’public hospital, If the medical criteria are met, the procedure is covered at no extra charge, so the out-of-pocket expenses are minimal. The main disadvantage is an often longer waiting time before the operation date.
In private clinic, This is the case for operations performed with Dr. Djian, the operation can be scheduled more quickly. Extra fees apply, but can be covered by a good mutual insurance company.
A detailed estimate will be given to you during the initial consultation, so that you can accurately anticipate your out-of-pocket expenses.
Breast reduction surgery lasts approximately 1 h 30 under general anaesthetic. In the majority of cases, the patient returns home the same evening. L’outpatient hospitalization is the standard protocol at Dr. Djian's practice. An overnight observation period can be arranged, depending on your medical history and distance from home. The next morning, you're at home.
Breast reduction leaves scars whose location is designed to be as discreet as possible. Depending on the technique used and the volume removed, they take the form of :
In the first few weeks after the operation, the scars are pink and slightly raised, a normal physiological reaction. The scar after breast reduction is gradually fading over 12 to 18 months to become thin and inconspicuous. Rigorous follow-up and the application of the healing treatments recommended by your surgeon will ensure an optimal aesthetic result.
The after-effects of breast reduction surgery are generally well tolerated. Mild to moderate pain may be experienced in the first few days, controlled by the painkillers prescribed.
A support bra must be worn continuously for 6 weeks to promote healing, it is not reimbursed by Social Security, but may be covered by certain mutual insurance companies.
The duration of the’work stoppage varies between 2 and 3 weeks depending on your professional activity. A sedentary job will enable you to resume work earlier than a physical or standing job. The resumption of sport activities involving the upper body (swimming, weight training, running) is generally not recommended during this period. 4 to 6 weeks.
Visible improvement is noticeable within the first few weeks, but you need to allow for 3 to 6 weeks so that swelling and bruising disappear. The final result, with the stable shape and contour of the breasts, stabilizes after 6 to 12 months, As the scars soften and the tissues regain their natural consistency.
Regular follow-up with Dr Djian is planned at each stage to support this evolution.
The initial consultation with Dr Djian is €100.
At the end of this consultation, you will leave with :
All post-operative follow-up consultations are included in the surgery package.
No, no prior agreement is required if breast reduction exceeds 300 grams per breast. and carries the code QEMA013 in the CCAM classification. In all other cases, an application may be required, particularly in the case of lower reduction or asymmetry.
Yes, the CPAM can reimburse a breast reduction from the age of 16 if the hypertrophy is proven. and causes physical or psychological problems. The indication must be established by a surgeon and validated by the attending physician or the health insurance medical service.
No, the support bra prescribed after breast surgery is not reimbursed by Social Security., even if the procedure is covered. It remains the patient's responsibility, but certain mutual insurance companies may offer a postoperative textile package.
Yes. If you benefit from Complémentaire Santé Solidaire (CSS, formerly CMU-C), If you are a female, you are entitled to reimbursement for breast reduction under the same conditions as an ordinary insured person, provided that the volume removed exceeds 300 g per breast. As the CSS acts as a mutual insurance company, it can cover part of the extra fees charged, subject to the legal ceilings applicable to sector 2 practitioners.
We recommend that you contact your health insurance fund directly to find out the exact amounts reimbursable before your procedure.
When breast reduction is reimbursed by Social Security under the corrective surgery, it entitles you to a compensated work stoppage.
The duration generally varies from 2 to 3 weeks, depending on your professional activity and recovery time. Sedentary work will often enable you to resume work more quickly than physical or standing work. Your surgeon will determine the appropriate duration for you during your post-operative follow-up.
Attention If the procedure is considered purely cosmetic (removal of less than 300 g), no sick leave is covered.
No. The isolated breast ptosis, i.e. a sagging breasts without breast hypertrophy proven, is not covered by Social Security, Even if it causes daily discomfort. To be reimbursed, the procedure must involve the removal of more than 300 g of glandular tissue per breast.
In certain cases, when ptosis is directly linked to breast hypertrophy, the surgeon can perform both corrections in the same operation. The CPAM reimbursement covers only the breast reduction procedure; the facelift component is not reimbursed separately. During your consultation, your surgeon will tell you what is reimbursed, depending on your situation.
Yes, in certain cases. When there is significant breast asymmetry, generally a a gap of at least two cup sizes between the two breasts, partial coverage may be considered. Most mutual insurance companies also reimburse unilateral breast reduction in cases of significant asymmetry, whether congenital or following cancer treatment.
Your situation will be assessed during the consultation with Dr. Djian, who will determine whether a request for prior agreement from the Assurance Maladie medical officer is necessary.
For under 35, a breast ultrasound can be requested instead of the mammography, depending on family history and the surgeon's clinical judgment.
Over 35, mammography is systematically performed. During your consultation, your surgeon will tell you which tests are necessary and how long they will take.
The initial consultation with Dr. Djian is €100. All post-operative follow-up consultations are included in the surgery package.
Dr Jérémy Djian is a plastic surgeon based at 5 square Thiers, near the Victor Hugo roundabout, in the 16th arrondissement of Paris.
He trained in Paris and remains attached to the hospital in the prestigious department of Pr Laurent Lantieri.
