Reconstructive Surgery

TRICARE covers cosmetic, reconstructive, and plastic surgery to improve your physical appearance only under these circumstances:

• Correction of a birth defect, including cleft lip
• Restoration of a body form following an accidental injury
• Revision of disfiguring and extensive scars resulting from neoplastic surgery, like surgery that removes a tumor or cyst
• Reconstructive breast surgery following a medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. mastectomy
• Reconstructive breast surgery due to a birth defect
• Penile implants and testicular prostheses for conditions resulting from organic origins or for organic impotency
• Surgery to correct pectus excavatum
• Panniculectomy, or tummy tuck, performed in conjunction with an abdominal or pelvic surgery. This is when a medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function.
• Liposuction, when medically necessary. This includes treatment for lipedema when you meet all the conditions below.
  • You have a clinical diagnosis of lipedema stage I, II, or III.
  • You’re 18 years old or older.
  • You have a body mass index of less than 30.
  • You have a documented record of pain and tenderness in affected areas, and the liposuction will significantly contribute to the safe and effective correction or improvement of your bodily function.
  • Your symptoms aren’t responding to at least six consecutive months of treatment.
  • An authorized surgeon trained in liposuction will perform the procedure.
  • You have a pre-authorization.

When must my surgery happen? Your surgery must happen no later than Dec. 31 of the year after your accidental injury or surgical trauma. The exceptions are:

• Postmastectomy reconstructive breast surgery
• Cases involving children who may require a growth period

Exclusions

TRICARE doesn’t cover cosmetic, reconstructive, or plastic surgery in the following cases: 

• Dental congenital anomalies
• Cosmetic procedures performed mainly for psychological or psychiatric reasons
• Elective correction of minor skin blemishes and marks
• Breast augmentation
• Procedures for personal reasons to improve appearance
• Facelifts
• Chemical peeling for aging skin, wrinkles, or acne
• Hair transplants
• Tattoo removal

The following procedures are excluded with limited exceptions. Check with your regional contractor for specific coverage details and requirements.

• Reduction mammoplasty, or breast reductions
• Blepharoplasty, or removal of excess skin on the eyelid
• Rhinoplasty, or nose surgery
• Otoplasty
• Revision of scars, except from neoplastic surgery
• Dermabrasion of the face
• Electrolysis or laser hair removal